# JACKIES RETIREMENT LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Jackies retirement alf
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073882783
- **Authorized official:** MS. JACQUELINE B WRIGHT (ADMINISTRATOR/OWNER)
- **Authorized official phone:** (321) 420-3916

## Contact information

- **Practice address:** 1675 CANON AVE NW, PALM BAY, FL 32907-8528
- **Practice address phone:** (321) 420-3916
- **Mailing address:** 1675 CANON AVE NW, PALM BAY, FL 32907-8528
- **Mailing address phone:** (321) 420-3916

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302F00000X | Exclusive Provider Organization | AL12053 | FL | Yes |

## Other

- **Enumeration date:** 12/26/2011
- **Last updated:** 12/26/2011