Individual
TEDRA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
782 E 130TH ST, CLEVELAND, OH 44108-2544
(216) 334-3163
Mailing address
782 E 130TH ST, CLEVELAND, OH 44108-2544
(216) 334-3163
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
OH
251X00000X
Supports Brokerage Agency
—
OH
253Z00000X
In Home Supportive Care Agency
—
OH
332U00000X
Home Delivered Meals
—
OH
3747P1801X
Personal Care Attendant
Primary
—
OH
Other
Enumeration date
09/08/2025
Last updated
09/08/2025
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