Provider Demographics
NPI:1073814893
Name:JACKSON SENIOR SERVICES, LLC
Entity type:Organization
Organization Name:JACKSON SENIOR SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:A
Authorized Official - Last Name:ERNST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-661-9888
Mailing Address - Street 1:420 CHEYENNE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-5412
Mailing Address - Country:US
Mailing Address - Phone:731-661-9888
Mailing Address - Fax:731-661-9056
Practice Address - Street 1:420 CHEYENNE DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-5412
Practice Address - Country:US
Practice Address - Phone:731-661-9888
Practice Address - Fax:731-661-9056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-10
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNACL0000000124311500000X, 385H00000X, 310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
No385H00000XRespite Care FacilityRespite Care