MEDICARE: YULANDER JACKSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	374U00000X	Home Health Aide
2	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care
3	376J00000X	Homemaker

General Provider Information

NPI Number	:	1841893708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YULANDER JACKSON

Provider Business Mailing Address
First Line	:	2189 MILES RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45231-2042
Country	:	US
Telephone Number	:	513-678-6040
Fax Number	:

Provider Business Practice Location Address
First Line	:	2189 MILES RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45231-2042
Country	:	US
Telephone Number	:	513-678-6040
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2020
Last Update Date	:	11/20/2020

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Directions to “ YULANDER JACKSON ” Practice Location

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