JACKSON GROUP HOME
Intermediate Care Facility, Mentally Retarded
Alexandria, Louisiana
Provider NPI: 1598784647
Organization Information:Organization Name: JACKSON GROUP HOME
Practice Location:
325 MCKEITHEN DRIVE ALEXANDRIA, LA 71303 US
Tel: 318-473-0217 Fax: --
Business Mailing Address:
,
Tel: -- Fax: --
Taxonomy:
Other Provider Identifiers:
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin
Practice Location:
325 MCKEITHEN DRIVE ALEXANDRIA, LA 71303 US
Tel: 318-473-0217 Fax: --
Business Mailing Address:
,
Tel: -- Fax: --
Taxonomy:
Primary | Code | Category/Description | State | License Number |
---|---|---|---|---|
Y | 315P00000X | Nursing & Custodial Care Facilities Intermediate Care Facility, Mentally Retarded | LA | 814 |
Other Provider Identifiers:
Issuer | Number | State | Type |
---|---|---|---|
UNISYS | 1713686 | LA | 01 |
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin