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Organization
KMJACKSON
Active
Organization
KMJACKSON
Active
Other names
KMJackson
Organization subpart
No
Provider details
NPI number
Authorized official
KATHRYN JACKSON (OWNER)
(330) 402-9641
Entity
Organization
Contact information
Practice address
2020 BROWNLEE AVE, YOUNGSTOWN, OH 44514-1016
(330) 402-9641
Mailing address
2020 BROWNLEE AVE, YOUNGSTOWN, OH 44514-1016
(330) 402-9641
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1073119525
NPI
OH
05
—
1235809237
—
OH
Enumeration date
09/20/2021
Last updated
01/02/2024
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