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Melvin Jackson
Emotionally Disturbed Childrens' Residential Treatment Facility in Avondale, Arizona
NPI 1831336411

Melvin Jackson is a Emotionally Disturbed Childrens' Residential Treatment Facility based in Avondale, AZ. Melvin Jackson practices in Avondale, AZ. The NPI Number for Melvin Jackson is 1831336411 and holds a License No. 11297 (Arizona).

The current practice location address for Melvin Jackson is 2415 N 124Th Cir, Avondale, AZ and can be reached out via phone at 602-841-3438.

Location: 2415 N 124Th Cir, Avondale, AZ, 85392-6509
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1831336411
Provider Name
Melvin Jackson
Credential
Provider Entity Type
Individual
Gender
Male
Address
2415 N 124Th Cir, Avondale, AZ, 85392-6509
Phone Number
602-841-3438
Fax Number
Provider Enumeration Date
01/19/2009
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
2415 N 124Th Cir
City
Avondale
State
Arizona
Zip
85392-6509
Phone Number
602-841-3438
Fax Number
person
Provider Business Mailing Address Details
Address
2415 N 124Th Cir
City
Avondale
State
Arizona
Zip
85392-6509
Phone Number
602-841-3438
Fax Number
person
Provider's Taxonomy Details 1
Type
Residential Treatment Facilities
Classification
Residential Treatment Facility, Emotionally Disturbed Children
Speciality
-
Taxonomy
322D00000X
License No.
11297 (Arizona)
Definition
A residential facility that provides habilitation services and other care and treatment to children diagnosed with mental health illness, behavioral issues, and intellectual disabilities and are not able to live independently.
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