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Mrs. Jacquenett Jackson
Adult Care Home Facility in Shubuta, Mississippi
NPI 1376727388

Jacquenett Jackson is an Adult Care Home Facility based in Shubuta, MS and is specialized in Adult Care Home. Jacquenett Jackson practices in Shubuta, MS. The NPI Number for Jacquenett Jackson is 1376727388 and holds a License No. (Mississippi).

The current practice location address for Jacquenett Jackson is 114 Second Street, Shubuta, MS and can be reached out via phone at 601-687-1128 and via fax at 601-687-5497.

Location: 114 Second Street, Shubuta, MS, 39360-0462
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1376727388
Provider Name
Jacquenett Jackson
Credential
Provider Entity Type
Individual
Gender
Female
Address
114 Second Street, Shubuta, MS, 39360-0462
Phone Number
601-687-1128
Fax Number
601-687-5497
Provider Enumeration Date
12/27/2007
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
00770581 05 MS
institution
Provider Business Practice Location Address Details
Address
114 Second Street
City
Shubuta
State
Mississippi
Zip
39360
Phone Number
601-687-1128
Fax Number
601-687-5497
person
Provider Business Mailing Address Details
Address
114 Second Street
City
Shubuta
State
Mississippi
Zip
39360
Phone Number
601-687-1128
Fax Number
601-687-5497
person
Provider's Taxonomy Details 1
Type
Nursing & Custodial Care Facilities
Classification
Custodial Care Facility
Speciality
Adult Care Home
Taxonomy
311ZA0620X
License No.
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Definition
A custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment.
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