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Organization

JACKSON INDEPENDENT LIVING, LLC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JIHAD JACKSON (CEO)
(262) 613-2960
Entity
Organization

Contact information

Practice address
2200 N COMMERCE ST, MILWAUKEE, WI 53212-3497
(262) 613-2960
Mailing address
N67W13215 DAYLILY DR, MENOMONEE FALLS, WI 53051-0504

Taxonomy

Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
823587205
WI
Enumeration date
12/06/2017
Last updated
06/16/2018
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