Provider Demographics
NPI:1104533207
Name:JACKIE'S CHOICE LLC
Entity type:Organization
Organization Name:JACKIE'S CHOICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:AMMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-477-6212
Mailing Address - Street 1:5324 ROMANCE LN
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45238-5224
Mailing Address - Country:US
Mailing Address - Phone:513-477-6212
Mailing Address - Fax:
Practice Address - Street 1:5324 ROMANCE LN
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-5224
Practice Address - Country:US
Practice Address - Phone:513-477-6212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care