1477598134 NPI number — JACKSON HOME CARE SERVICES LLC

Table of content: (NPI 1477598134)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477598134 NPI number — JACKSON HOME CARE SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JACKSON HOME CARE SERVICES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477598134
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/09/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9510 ORMSBY STATION RD
Provider Second Line Business Mailing Address:
STE 300
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40223-4081
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-891-1187
Provider Business Mailing Address Fax Number:
502-891-8067

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
37 SANDSTONE CIR
Provider Second Line Business Practice Location Address:
STE 201
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38305-2073
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
731-736-3700
Provider Business Practice Location Address Fax Number:
731-736-3704
Provider Enumeration Date:
06/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LYLES
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
TODD
Authorized Official Title or Position:
SR VICE PRESIDENT
Authorized Official Telephone Number:
502-891-1044

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  0000000178 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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