Individual
LADONNA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1866 N MARBLE RIDGE PL, TUCSON, AZ 85715-4574
(520) 722-9296
Mailing address
1866 N MARBLE RIDGE PL, TUCSON, AZ 85715-4574
(520) 722-9296
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
BH-2808
AZ
385H00000X
Respite Care
Primary
BH4932
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
764721
—
AZ
01
—
BH4932
AZ DEPT OF HEALTH SERVICES
AZ
Enumeration date
11/21/2006
Last updated
07/27/2020
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