| Doctor Name: | THERESA JACKSON |
| NPI Number: | 1104207083 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 2383432582 |
| Business Practice Address: | 77 E Great Lakes St Apt 303 River Rouge, MI - 482181584 |
| Business Phone Number: | 3132084140 |
| Business Fax Number: | |
| Mailing Address: | 77 E Great Lakes St Apt 303, RIVER ROUGE |
| State: | MI |
| Postal Code: | 482181584 |
| Phone Number: | 3132084140 |
| Fax Number: | |
| NPI Enumeration Date: | 06/16/2015 |
| NPI Last Update Date: | 06/16/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 372500000X |
| License Number: | 2383432582 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Nursing Service Related Providers |
| Taxonomy Classification: | Chore Provider |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual who provides home maintenance services required to sustain a safe, sanitary living environment for individuals who because of age or disabilities is unable to perform the activities. These services include heavy household chores such as washing floors, windows, and walls; tacking down loose rugs and tiles; and moving heavy items of furniture in order to provide safe access and egress. |