Individual
MS. MELODY JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1667 N ALLISON ST, PHILADELPHIA, PA 19131-3530
(267) 658-9971
Mailing address
1667 N ALLISON ST, PHILADELPHIA, PA 19131-3530
(267) 658-9971
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
61203601
PA
253Z00000X
In Home Supportive Care Agency
Primary
61203601
PA
376J00000X
Homemaker
61203601
PA
385H00000X
Respite Care
61203601
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
61203601
—
PA
Enumeration date
10/25/2021
Last updated
05/23/2022
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