JACKSONSCOTT2 (NPI# 1154869410) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154869410 |
| Entity Type | Organization |
| Organization Name | JACKSONSCOTT2 |
| Practice Address |
4573 N. 22nd Street Milwaukee WI 53209 |
| Mailing Address |
4573 N 22nd St Milwaukee WI 53209-6309 |
| Practice Telephone | 4145172825 |
| Mailing Telephone | 4145172825 |
| Enumeration Date | 2017-02-07 |
| Last Update Date | 2017-02-07 |
| Authorized Official Name | LATASHA JACKSON (LPN) |
| Authorized Official Telephone | 4145172825 |
| Authorized Official Credential | LPN |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3140N1450X |
Skilled Nursing Facility Specialization: Nursing Care, Pediatric |
317445-31 | WI | Nursing & Custodial Care Facilities |
| Street Address |
4573 N. 22ND STREET |
| City | MILWAUKEE |
| State | WI |
| Zip Code | 53209 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780238253 | Niajcia Brookshire | Counselor | 3900 W Brown Deer Rd Suite 200, Brown Deer, WI 53209 | 2019-08-01 |
| 1740751015 | Mary Fuller | Home Health Aide | 3043 N 29th St., Milwaukee, WI 53209 | 2018-12-16 |
| 1669910469 | Dimera House | In Home Supportive Care | 4002 W Fairount Ave, Milwaukee, WI 53209 | 2017-02-01 |
| 1891248340 | Amy L May | Nurse Practitioner | 3303 W Good Hope Rd, Milwaukee, WI 53209 | 2016-08-02 |
| 1871980193 | Alan R Rosenthal | Pharmacist | 6930 N Beech Tree Dr, Milwaukee, WI 53209 | 2015-04-24 |
| 1104212380 | Reema Shah | Student in an Organized Health Care Education/Training Program | 2400 W. Villard Ave, Milwaukee, WI 53209 | 2015-04-14 |
| 1336534403 | Robert Michael Kitsis | Family Medicine | 9252 N Green Bay Rd Fl 2, Brown Deer, WI 53209 | 2015-04-05 |
| 1962891994 | Kls Community Outreach Teen Center Consulting and Management L.L.C. | Public Health or Welfare | 8330 North Teutonia Ave Suite 103, Brown Deer, WI 53209 | 2015-01-14 |
| 1548659634 | Kls Community Outreach Teen Center Consulting and Management L.L.C. | Early Intervention Provider Agency | 8330 North Teutonia Avenue Suite 103, Brown Deer, WI 53209 | 2015-01-13 |
| 1518361575 | Constance Leachelle Beard | Licensed Practical Nurse | 5337 N. 34th Street, Milwaukee, WI 53209 | 2014-10-20 |
| Find all providers in zip 53209 | ||||
| Taxonomy Code | 3140N1450X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Skilled Nursing Facility |
| Specialization | Nursing Care, Pediatric |
| A nursing care facility designed and staffed for the provision of nursing care and appropriate educational and habilitative/rehabilitative services to children with multiple, complex or profound disabilities that can not be cared for in a less restrictive environment. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023367612 | Johnnie Mae Simmons | Skilled Nursing Facility | 4560 N. 40th St, Milwaukee, WI 53209 | 2012-08-29 |
| 1356303101 | Jeannette Ponder | Skilled Nursing Facility | 3152 N 24th Pl, Milwaukee, WI 53206-1209 | 2006-04-06 |
| 1013275775 | Destani's Child Medical Day Care Provider, Inc | Skilled Nursing Facility | 3062 N 58th St, #1, Milwaukee, WI 53210-1545 | 2012-05-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720450125 | Independent Nursing | Skilled Nursing Facility | 143 E Pine Hollow Ln Apt 1, Oak Creek, WI 53154-7714 | 2015-10-24 |
| 1528472024 | Colleen L Biller | Skilled Nursing Facility | 1421 S 17th St, Sheboygan, WI 53081-5123 | 2014-06-12 |
| 1154754620 | Private Duty Nursing Service | Skilled Nursing Facility | 1538 Troy Dr Apt 1, Madison, WI 53704-2074 | 2013-08-19 |
| 1629302872 | Ashley Zimdahl | Skilled Nursing Facility | N2364 Sunset Dr, Campbellsport, WI 53010-2038 | 2009-09-21 |
| 1760634729 | Regina Angela Lanza | Skilled Nursing Facility | W193s7842 Overlook Bay Rd # 6d, Muskego, WI 53150-7813 | 2008-10-21 |
| 1881865012 | Lisa Salaway | Skilled Nursing Facility | 510 Cabrillo Ct, Verona, WI 53593-8233 | 2008-03-16 |
| 1538353982 | Wisconsin Medicaid | Skilled Nursing Facility | 1528 Remington Rd, Neenah, WI 54956-1696 | 2007-08-29 |
| 1336340561 | Badgerland Billing LLC | Skilled Nursing Facility | 2632 Smithfield Dr, Fitchburg, WI 53719-1665 | 2007-05-28 |
| 1336109776 | Medicaid | Skilled Nursing Facility | 1125 Geneva Rd, Menasha, WI 54952-1505 | 2006-03-27 |
| 1558912691 | Bedrock Hcs At Greendale LLC | Skilled Nursing Facility | 5404 W Loomis Rd, Greendale, WI 53129-1411 | 2019-09-20 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.