Individual
VANESSA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2922 FALCON AVE, FAR ROCKAWAY, NY 11691-1845
(347) 576-9654
Mailing address
2922 FALCON AVE, FAR ROCKAWAY, NY 11691-1845
(347) 576-9654
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
320584
NY
Other
Enumeration date
01/05/2015
Last updated
01/05/2015
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