Provider Demographics
NPI:1487340808
Name:JACKSON'S HOMES LLC
Entity type:Organization
Organization Name:JACKSON'S HOMES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CORRISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:WEAVEER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-557-3413
Mailing Address - Street 1:16160 BAYLIS ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-3101
Mailing Address - Country:US
Mailing Address - Phone:586-557-3433
Mailing Address - Fax:
Practice Address - Street 1:16160 BAYLIS ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48221-3101
Practice Address - Country:US
Practice Address - Phone:586-557-3413
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-18
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care