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Jerome Alexander-terrell Jackson
Foster Care Agency in Peoria, Arizona
NPI 1740815497

Jerome Alexander-terrell Jackson is a Foster Care Agency based in Peoria, AZ. Jerome Alexander-terrell Jackson practices in Peoria, AZ. The NPI Number for Jerome Alexander-terrell Jackson is 1740815497 and holds a License No. 10195508 (Arizona).

The current practice location address for Jerome Alexander-terrell Jackson is 9680 W Northern Ave Unit 2311, Peoria, AZ and can be reached out via phone at 989-980-8286 and via fax at 602-455-4626.

Location: 9680 W Northern Ave Unit 2311, Peoria, AZ, 85345-4655
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1740815497
Provider Name
Jerome Alexander-terrell Jackson
Credential
Provider Entity Type
Individual
Gender
Male
Address
9680 W Northern Ave Unit 2311, Peoria, AZ, 85345-4655
Phone Number
989-980-8286
Fax Number
602-455-4626
Provider Enumeration Date
03/03/2020
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
9680 W Northern Ave Unit 2311
City
Peoria
State
Arizona
Zip
85345-4655
Phone Number
989-980-8286
Fax Number
602-455-4626
person
Provider Business Mailing Address Details
Address
9680 W Northern Ave Unit 2311
City
Peoria
State
Arizona
Zip
85345-4655
Phone Number
989-980-8286
Fax Number
602-455-4626
person
Provider's Taxonomy Details 1
Type
Agencies
Classification
Foster Care Agency
Speciality
-
Taxonomy
253J00000X
License No.
10195508 (Arizona)
Definition
A Foster Care Agency is an agency that provides foster care as defined in the Code of Federal Regulations (CFR) as "24-hour substitute care for children outside their own homes." Foster care settings include, but are not limited to, nonrelative foster family homes, relative foster homes (whether payments are being made or not), group homes, emergency shelters, residential facilities, and pre-adoptive homes.
person
Provider's Taxonomy Details 2
Type
Respite Care Facility
Classification
Respite Care
Speciality
Respite Care, Mental Illness, Child
Taxonomy
385HR2055X
License No.
10195508 (Arizona)
Definition
A facility or distinct part of a facility that provides short term, residential care to children, diagnosed with mental illness, as respite for the regular caregivers.
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