Organization
JACKIES RETIREMENT LLC
Active
Other names
Jackies retirement alf
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JACQUELINE B WRIGHT (ADMINISTRATOR/OWNER)
(321) 420-3916
Entity
Organization
Contact information
Practice address
1675 CANON AVE NW, PALM BAY, FL 32907-8528
(321) 420-3916
Mailing address
1675 CANON AVE NW, PALM BAY, FL 32907-8528
(321) 420-3916
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
AL12053
FL
Other
Enumeration date
12/26/2011
Last updated
12/26/2011
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