Organization
JACKSON FAMILY HOMES, INC.
Active
Other names
Jackson Support Services, Inc
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROSEMARY HELEN JACKSON PH.D. (PRESIDENT/CEO)
(704) 846-2295
Entity
Organization
Contact information
Practice address
11808 PROVINCETOWNE DR, CHARLOTTE, NC 28277-9165
(704) 846-2295
(704) 332-3510
Mailing address
11808 PROVINCETOWNE DR, CHARLOTTE, NC 28277-9165
(704) 846-2295
(704) 332-3510
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
8301472
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6603382
—
NC
05
—
6603584
—
NC
05
—
8301472
—
NC
Enumeration date
10/10/2006
Last updated
08/22/2020
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