Individual
BEATRICE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
14100 BARDWELL AVENUE, EAST CLEVELAND, OH 44112
(216) 212-1727
Mailing address
14100 BARDWELL AVENUE, EAST CLEVELAND, OH 44112
(216) 212-1727
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
2998083
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2998083
—
OH
Enumeration date
10/23/2014
Last updated
10/23/2014
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