JALISA JACKSON (NPI# 1366041667) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366041667 |
| Entity Type | Individual |
| Full Name | JALISA JACKSON |
| Practice Address |
11413 Mangla Dr Charlotte NC 28214-8885 |
| Practice Telephone | 7048194909 |
| Mailing Telephone | 7048194909 |
| Enumeration Date | 2020-10-19 |
| Last Update Date | 2020-10-19 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320800000X | Community Based Residential Treatment Facility, Mental Illness | MHL-036-348 | NC | Residential Treatment Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114401825 | Jalisa D Jackson | Case Manager/Care Coordinator | 915 Washington St, Franklinton, LA 70438-1718 | 2018-09-18 |
| 1982131421 | Jalisa Jackson | Counselor | 3308 Tulane Ave Ste 407, New Orleans, LA 70119-7158 | 2017-05-15 |
| Street Address |
11413 MANGLA DR |
| City | CHARLOTTE |
| State | NC |
| Zip Code | 28214-8885 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346840261 | Urbanized LLC | Community Based Residential Treatment Facility, Mental Illness | 11413 Mangla Dr, Charlotte, NC 28214-8885 | 2020-10-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104456011 | Regina Williams | Custodial Care Facility | 511 Tansy Drive, Charlotte, NC 28214 | 2020-01-20 |
| 1104473974 | Daquan Ford | Technician | 7011 Hunters Glen Drive, Charlotte, NC 28214 | 2019-08-26 |
| 1457836736 | Miracle Houses, Inc. | Community Based Residential Treatment Facility, Mental Illness | 7827 Kerry Brook Circle, Charlotte, NC 28214 | 2018-10-02 |
| 1912481029 | Charlotte Afriyie | Behavior Technician | 2122 Sonoma Valley Drive, Charlotte, NC 28214 | 2018-09-25 |
| 1588161350 | Future Impression | Counselor | 619 Sullivan Street, Charlotte, NC 28214 | 2018-04-09 |
| 1588072326 | Key Choice Counseling | Community/Behavioral Health | 2909 Berry Creek Rd., Charlotte, NC 28214 | 2014-07-24 |
| 1255751699 | Joyce Patterson Melton | Registered Nurse | 7409 Pawtuckett Rd, Charlotte, NC 28214 | 2014-04-24 |
| 1407271109 | Central Carolina Medical Clinic, Pa | Internal Medicine | 515 Little Rock Road, Charlotte, NC 28214 | 2014-03-04 |
| 1063764702 | Autism Services of Mecklenburg County, Inc. | Intermediate Care Facility, Mentally Retarded | 5917 Rowan Way, Charlotte, NC 28214 | 2012-10-04 |
| 1043569460 | Loretta Massey | Social Worker | 2202 Lisa Carole Drive, Charlotte, NC 28214 | 2012-08-30 |
| Find all providers in zip 28214 | ||||
| Taxonomy Code | 320800000X |
| Grouping | Residential Treatment Facilities |
| Classification | Community Based Residential Treatment Facility, Mental Illness |
| A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457836736 | Miracle Houses, Inc. | Community Based Residential Treatment Facility, Mental Illness | 7827 Kerry Brook Circle, Charlotte, NC 28214 | 2018-10-02 |
| 1306353248 | Families United | Community Based Residential Treatment Facility, Mental Illness | 6610 Harburn Forest Dr, Charlotte, NC 28269-6912 | 2017-12-31 |
| 1013466416 | Roha Solutions, Inc | Community Based Residential Treatment Facility, Mental Illness | 1529 Jennings St, Charlotte, NC 28216 | 2016-09-26 |
| 1104270636 | Dennis Griffin's Consulting | Community Based Residential Treatment Facility, Mental Illness | 4428 Staffordshire Ln, Charlotte, NC 28213-4238 | 2016-04-21 |
| 1336579077 | Growth and Wellness Center, LLC. | Community Based Residential Treatment Facility, Mental Illness | 12001 Olympic Club Dr, Charlotte, NC 28277-4057 | 2013-11-15 |
| 1912267477 | Between Faces Foundation, Inc | Community Based Residential Treatment Facility, Mental Illness | 13000 S Tryon St Ste F-179, Charlotte, NC 28278-7652 | 2012-05-17 |
| 1194084194 | Promising Youth & Adults Behavioral Healthcare, Inc | Community Based Residential Treatment Facility, Mental Illness | 2750 E Wt Harris Blvd Ste 105, Charlotte, NC 28213-4286 | 2012-05-10 |
| 1265747349 | Primary Care Solutions Inc | Community Based Residential Treatment Facility, Mental Illness | 6807 Idlewild Brook Ln, Charlotte, NC 28212-5858 | 2010-08-12 |
| 1902110828 | Primary Care Solutions Inc. | Community Based Residential Treatment Facility, Mental Illness | 2744 Fairstone Ave, Charlotte, NC 28269-5412 | 2010-08-03 |
| 1952531717 | Mecklenburg Open Door, Inc. | Community Based Residential Treatment Facility, Mental Illness | 3950 Freedom Dr, Charlotte, NC 28208-2292 | 2009-07-15 |
| Find all providers in CHARLOTTE | ||||
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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.