Individual
CYNTHIA RANA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1206 W CENTRAL AVE, COOLIDGE, AZ 85128-9165
(480) 886-9693
Mailing address
1206 W CENTRAL AVE, COOLIDGE, AZ 85128-9165
(480) 886-9693
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
374U00000X
Home Health Aide
Primary
—
—
376J00000X
Homemaker
—
—
385H00000X
Respite Care
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
468301
AHCCCS
—
Enumeration date
01/22/2020
Last updated
01/22/2020
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