MEDICARE: JIHAD JACKSON

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency		WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891224770
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIHAD JACKSON

Provider Business Mailing Address
First Line	:	8643 N TEAL CT
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53223-2726
Country	:	US
Telephone Number	:	414-334-5791
Fax Number	:

Provider Business Practice Location Address
First Line	:	8643 N TEAL CT
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53223-2726
Country	:	US
Telephone Number	:	414-334-5791
Fax Number	:

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

Provider Enumeration Date	:	06/05/2017
Last Update Date	:	06/07/2026

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Directions to “ JIHAD JACKSON ” Practice Location

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