| Jackson Support Services, Inc | |
|
11808 Provincetowne Dr Charlotte NC 28277-9165 | |
| (704) 846-2295 | |
| (704) 332-3510 |
| Full Name | Jackson Support Services, Inc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 11808 Provincetowne Dr, Charlotte, North Carolina |
| Authorized Official Name and Position | Rosemary Helen Jackson (PRESIDENT/CEO) |
| Authorized Official Contact | 7048462295 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jackson Support Services, Inc 11808 Provincetowne Dr Charlotte NC 28277-9165 Ph: (704) 846-2295 | Jackson Support Services, Inc 11808 Provincetowne Dr Charlotte NC 28277-9165 Ph: (704) 846-2295 |
| NPI Number | 1629166327 |
|---|---|
| Provider Enumeration Date | 10/10/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629166327 | NPI | - | NPPES |
| 6603382 | Medicaid | NC | |
| 6603584 | Medicaid | NC | |
| 8301472 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 8301472 (North Carolina) | Primary |
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