Organization
JACKSON HOME FOR VETERANS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEVAR LAFAYETTE JACKSON (OWNER)
(704) 315-7089
Entity
Organization
Contact information
Practice address
2633 JUNIPER DR, CHARLOTTE, NC 28269-4004
(704) 315-7089
Mailing address
2633 JUNIPER DR, CHARLOTTE, NC 28269-4004
(704) 315-7089
Taxonomy
Speciality
Code
Description
License number
State
177F00000X
Lodging Provider
Primary
—
—
261QM1000X
Migrant Health Clinic/Center
—
—
302R00000X
Health Maintenance Organization
—
—
Other
Enumeration date
10/20/2020
Last updated
10/23/2020
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