# JACKSON GROUP HOME

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** WESTSIDE HABILITATION CENTER, INC.
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1598784647
- **Legal business name:** WESTSIDE HABILITATION CENTER, INC.
- **Authorized official:** MS. CHRISTINA BONNETTE BOLTON (ADMINISTRATOR)
- **Authorized official phone:** (318) 445-1551

## Contact information

- **Practice address:** 325 MCKEITHEN DRIVE, ALEXANDRIA, LA 71303
- **Practice address phone:** (318) 473-0217
- **Practice address fax:** (318) 473-0256
- **Mailing address:** PO BOX 7917, ALEXANDRIA, LA 71306-0917
- **Mailing address phone:** (318) 445-1551
- **Mailing address fax:** (318) 445-1242

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 315P00000X | Intellectual Disabilities Intermediate Care Facility | 814 | LA | Yes |

## Other

- **Enumeration date:** 07/19/2006
- **Last updated:** 11/07/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1713686 | UNISYS | LA |