JACKSON HOME, INC. (NPI# 1285838805) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1285838805 |
| Entity Type | Organization |
| Organization Name | JACKSON HOME, INC. |
| Practice Address |
509 Holly St Fairmont NC 28340-1705 |
| Practice Telephone | 9106287171 |
| Enumeration Date | 2007-06-14 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MRS. GLENDA T JACKSON (DIRECTOR) |
| Authorized Official Telephone | 9106287171 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | MHL078158 | NC | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 6603889 | 05 |
| Street Address |
509 HOLLY ST |
| City | FAIRMONT |
| State | NC |
| Zip Code | 28340-1705 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023250347 | Independent Community-based Services LLC | Home Health | 107 N Morro St., Fairmont, NC 28340 | 2009-04-01 |
| 1801960083 | Greenbrier Ltc Inc | Assisted Living Facility | 703 South Walnut St, Fairmont, NC 28340 | 2006-11-20 |
| 1275969487 | Robeson Health Care Corporation | Pharmacy | 1212 S Walnut St, Fairmont, NC 28340 | 2013-09-19 |
| 1033221130 | Jeffrey Lemont Hunter | Counselor | 314 S Main St, Fairmont, NC 28340 | 2006-08-31 |
| 1912924648 | Danny Cox | Durable Medical Equipment & Medical Supplies | 234 S Main St, Homecare Medical Products, Fairmont, NC 28340 | 2006-07-17 |
| 1417914722 | Robeson Health Care Corporation | Counselor | 1212 S Walnut St, Fairmont, NC 28340 | 2006-04-28 |
| 1952768426 | Latanya Breeden | Adult Companion | 609 Martin Luther King Dr, Fairmont, NC 28340-1311 | 2016-01-28 |
| 1033252440 | Stephens Outreach Center, Inc | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 608a Martin Luther King Dr, Fairmont, NC 28340-1312 | 2007-02-15 |
| 1629027842 | James Clifton Herring Jr. | Optometrist | 1516 Alexander St, Fairmont, NC 28340-1406 | 2006-05-06 |
| 1225142391 | Sean Brian Woken | Chiropractor | 208 Iona St, Fairmont, NC 28340-1616 | 2006-08-18 |
| Find all providers in zip 28340 | ||||
| Taxonomy Code | 322D00000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Emotionally Disturbed Children |
| A provider facility or distinct part of the organization which renders an interdisciplinary program of mental health treatment to individuals under 21 years of age who have persistent dysfunction in major life areas. The dysfunction is of an extent and pervasiveness that requires a protected and highly structured therapeutic environment. These organizations, or distinct part of organizations, exclude those that provide acute psychiatric care, partial hospitalization, group living, therapeutic schooling, primary diagnosis substance abuse disorder treatment, or primary diagnosis mental retardation or developmental disability treatment. |
| Notes: Source: U.S. Department of Defense Regulation 6010.8-R, Chapter 6. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649664855 | Yale Academy LLC | Residential Treatment Facility, Emotionally Disturbed Children | 7 Crosswinds Dr, Fairmont, WV 26554-9193 | 2015-03-25 |
| 1295972248 | Yore Academy, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 7 Crosswind Drive, Fairmont, WV 26554 | 2009-01-13 |
| 1447425459 | Stepping Stone, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | Rr 6 Box 160c, Fairmont, WV 26554-9116 | 2008-04-30 |
| 1447399134 | The Rossberry Home of Fairmont, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 13178 Nc Highway 130 E, Fairmont, NC 28340-9597 | 2007-02-06 |
| 1922445790 | Cornerstone Treatment Faciltiy | Residential Treatment Facility, Emotionally Disturbed Children | 13178 Nc Highway 130 E, Fairmont, NC 28340-9597 | 2013-06-03 |
| 1750508040 | Youth Academy, LLC | Residential Treatment Facility, Emotionally Disturbed Children | 3 Crosswinds Dr, Fairmont, WV 26554-9193 | 2007-04-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023617255 | Creative Helping Hands LLC | Residential Treatment Facility, Emotionally Disturbed Children | 478 Green Lake Rd, Rockingham, NC 28379-7850 | 2020-10-19 |
| 1083237986 | Revive Housing LLC | Residential Treatment Facility, Emotionally Disturbed Children | 210 Sunset Dr Apt 615, Salisbury, NC 28147-7147 | 2020-05-26 |
| 1457998627 | Re Health Group | Residential Treatment Facility, Emotionally Disturbed Children | 1102 Groves St, Kings Mountain, NC 28086-2232 | 2019-12-05 |
| 1821631532 | Marquita Latrice Walls | Residential Treatment Facility, Emotionally Disturbed Children | 1565 Longbranch Rd, Grover, NC 28073-9599 | 2019-10-25 |
| 1699233866 | A Brighter Path LLC | Residential Treatment Facility, Emotionally Disturbed Children | 120 Jetter Rd, Grover, NC 28073-9687 | 2019-03-06 |
| 1821562224 | Carter Clinic, Pa | Residential Treatment Facility, Emotionally Disturbed Children | 703 W 3rd Ave Bldg A, Red Springs, NC 28377-1524 | 2019-01-18 |
| 1659842607 | Gervonia Robinson | Residential Treatment Facility, Emotionally Disturbed Children | 1714 Aster Ln, Gastonia, NC 28054-8303 | 2018-12-16 |
| 1679058440 | Miracle Houses Inc | Residential Treatment Facility, Emotionally Disturbed Children | 7827 Kerrybrook Cir, Charlotte, NC 28214-2513 | 2018-09-27 |
| 1174048078 | A Safe Place Community Housing, LLC | Residential Treatment Facility, Emotionally Disturbed Children | 2049 Highland St, Charlotte, NC 28208-4909 | 2017-08-11 |
| 1104346881 | Inspiration for Us | Residential Treatment Facility, Emotionally Disturbed Children | 1205 W Mountain St, Kernersville, NC 27284-2173 | 2017-06-22 |
| 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.