Individual
DESHAWNTE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12617 MAPLE LEAF DR, GARFIELD HTS, OH 44125-4026
(502) 249-4758
Mailing address
12617 MAPLE LEAF DR, GARFIELD HTS, OH 44125-4026
(502) 249-4758
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
376J00000X
Homemaker
Primary
—
—
385H00000X
Respite Care
—
—
Other
Enumeration date
07/16/2024
Last updated
07/16/2024
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