Organization Name: | NEW JACKSON MANOR, LLC |
NPI Number: | 1407845639 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ROBIN L. BARBER (VICE PRESIDENT) |
Mailing Address: | 68 Hwy 3444 Annville |
State: | KY US |
Postal Code: | 40402 |
Phone Number: | 6063645197 |
Fax Number: | 6063642293 |
NPI Enumeration Date: | 10/20/2005 |
NPI Last Update Date: | 10/23/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QA0600X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Adult Day Care |
Taxonomy Definition: |