Organization
GLORIA JACKSON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GLORIA JACKSON (LPN)
(631) 226-3901
Entity
Organization
Contact information
Practice address
525 S 9TH ST, LINDENHURST, NY 11757-4529
(631) 226-3901
Mailing address
525 S 9TH ST, LINDENHURST, NY 11757-4529
(631) 226-3901
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
252415-1
NY
Other
Enumeration date
05/05/2013
Last updated
05/05/2013
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