Individual
CARMEN JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1799 STUMPF BLVD, TERRYTOWN, LA 70056-3950
(504) 227-1492
Mailing address
1799 STUMPF BLVD, TERRYTOWN, LA 70056-3950
(504) 227-1492
Taxonomy
Speciality
Code
Description
License number
State
311Z00000X
Custodial Care Facility
Primary
—
LA
Other
Enumeration date
02/25/2015
Last updated
02/25/2015
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