Provider Demographics
NPI:1407670896
Name:JACKSON-RICHMOND PROPERTIES LLC
Entity type:Organization
Organization Name:JACKSON-RICHMOND PROPERTIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TANIKA
Authorized Official - Middle Name:SHAKITA
Authorized Official - Last Name:JACKSON-RICHMOND
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, MSN,ED,RN
Authorized Official - Phone:813-352-8824
Mailing Address - Street 1:3420 DELEUIL AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33610-3621
Mailing Address - Country:US
Mailing Address - Phone:813-352-8824
Mailing Address - Fax:
Practice Address - Street 1:3420 DELEUIL AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610-3621
Practice Address - Country:US
Practice Address - Phone:813-352-8824
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-12
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities