MRS. JACQUENETT JACKSON

Adult Care Home

Shubuta, Mississippi

Provider NPI: 1376727388

Provider Information:
MRS. JACQUENETT  JACKSON 


Practice Location:
114 SECOND STREET  SHUBUTA, MS 39360 US
Tel: 601-687-1128  Fax: --

Business Mailing Address:
  ,   
Tel: --  Fax: --


Taxonomy:

Primary	Code	Category/Description	State	License Number
Y	311ZA0620X	Nursing & Custodial Care Facilities Custodial Care Facility Adult Care Home

Other Provider Identifiers:

Issuer	Number	State	Type
	00770581	MS	05

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin