MRS. JACQUENETT JACKSON (NPI# 1376727388) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376727388 |
| Entity Type | Individual |
| Full Name | MRS. JACQUENETT JACKSON |
| Other Name | ANNETTE SMITH |
| Practice Address |
114 Second Street Shubuta MS 39360 |
| Mailing Address |
Po Box 462 Shubuta MS 39360-0462 |
| Practice Telephone | 6016871128 |
| Practice Fax Number | 6016875497 |
| Mailing Telephone | 6016871128 |
| Mailing Fax Number | 6016875497 |
| Enumeration Date | 2007-12-27 |
| Last Update Date | 2007-12-27 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 311ZA0620X |
Custodial Care Facility Specialization: Adult Care Home |
Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 00770581 | 05 |
| Street Address |
114 SECOND STREET |
| City | SHUBUTA |
| State | MS |
| Zip Code | 39360 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851903264 | Irvin Charles Jackson | Non-emergency Medical Transport (VAN) | 327 East Street, Shubuta, MS 39360 | 2020-08-18 |
| 1053882415 | Debra Eloise Bender | Non-emergency Medical Transport (VAN) | 6320 County Road 610, Shubuta, MS 39360 | 2018-12-11 |
| 1457477481 | Virgie C Wade | Nurse Practitioner | 130 North High St, Shubuta, MS 39360 | 2007-03-21 |
| 1548359565 | Outreach Health Services,inc. | Clinic/Center | 130 North High Street, Shubuta, MS 39360 | 2006-10-11 |
| 1568095453 | Robert William Dycus | Nurse Practitioner | 130 N. High Street, Shubuta, MS 39360-3936 | 2020-02-19 |
| 1568644383 | Superior Home Care | Early Intervention Provider Agency | 130 County Road 2700, Shubuta, MS 39360-8600 | 2007-12-04 |
| 1881921682 | Superior Home Care | Respite Care | 130 County Road 2700, Shubuta, MS 39360-8600 | 2009-11-16 |
| 1912903766 | Karen Parker | Nurse Practitioner | 130n High St, Shubuta, MS 39360-8870 | 2005-06-27 |
| 1578920328 | Shanika Boyd | Nurse Practitioner | 130 N High St, Shubuta, MS 39360-8870 | 2016-01-25 |
| 1811367048 | Patricia Simpson | Nurse Practitioner | 130 N High St, Shubuta, MS 39360-8870 | 2015-09-30 |
| Find all providers in zip 39360 | ||||
| Taxonomy Code | 311ZA0620X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Custodial Care Facility |
| Specialization | Adult Care Home |
| A custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912540428 | Jennifer Lashon May | Custodial Care Facility | 141 Jefferson Street Ste, C, Monticello, MS 39654-3965 | 2019-10-28 |
| 1255866059 | Personal Touch LLC | Custodial Care Facility | 614 Chippewah Dr, Laurel, MS 39443-7413 | 2017-04-29 |
| 1164964003 | Creative Image Personal Care Service LLC | Custodial Care Facility | 503 Highway 82 E, Indianola, MS 38751-2317 | 2016-11-09 |
| 1679943310 | Educare Senior Day Center (vicksburg Branch) | Custodial Care Facility | 3202 Wisconsin Ave, Vicksburg, MS 39180-5351 | 2015-10-06 |
| 1659747988 | Aging Gracefully Community Center | Custodial Care Facility | 16165 Highway 51, Hazlehurst, MS 39083-2002 | 2015-08-20 |
| 1215315528 | Serenityhomecare | Custodial Care Facility | 1512 Clinton Raymond Rd, Clinton, MS 39056-5400 | 2015-05-07 |
| 1356765101 | Healthyland Adult Day Care, LLC | Custodial Care Facility | 227 Pecan Street, Marks, MS 38646 | 2014-02-14 |
| 1164845210 | R S Enterprise | Custodial Care Facility | 532 Burns St, Jackson, MS 39203-3601 | 2014-01-26 |
| 1053746487 | Assurance Home Care Agency LLC | Custodial Care Facility | 1549 Shiloh Church Rd, Newton, MS 39345-9024 | 2013-09-04 |
| 1790119519 | Pressicare, Inc | Custodial Care Facility | 20434 Old Houston Rd, Aberdeen, MS 39730-8548 | 2013-08-28 |
| 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.