BUCKEYE J, LLC (NPI# 1457342289) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457342289 |
| Entity Type | Organization |
| Organization Name | BUCKEYE J, LLC |
| Other Organization Name | JACKSON MANOR NURSING HOME |
| Practice Address |
710 Broadridge Dr Jackson MO 63755-3042 |
| Mailing Address |
12136 W Bayaud Ave Suite 200 Lakewood CO 80228-2115 |
| Practice Telephone | 5732433101 |
| Practice Fax Number | 5732436742 |
| Mailing Telephone | 3032383838 |
| Mailing Fax Number | 3039870434 |
| Enumeration Date | 2005-11-01 |
| Last Update Date | 2016-04-25 |
| Authorized Official Name | JAY MOSKOWITZ (PRESIDENT) |
| Authorized Official Telephone | 3032383838 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 314000000X | Skilled Nursing Facility | 031659 | MO | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 101456606 | 05 |
| Other Name | Type Code |
|---|---|
| Jackson Manor Nursing Home | Doing Business As Name - Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Colorado Business Entities | Buckeye J, LLC | 12136 W Bayaud Ave Ste 200, Lakewood, CO 80228 |
| Street Address |
710 BROADRIDGE DR |
| City | JACKSON |
| State | MO |
| Zip Code | 63755-3042 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366073496 | Tamara L Goldrick | Social Worker | 710 Broadridge Dr, Jackson, MO 63755-3042 | 2020-01-28 |
| 1689029753 | Sarah Fyfe | Occupational Therapy Assistant | 710 Broadridge Dr, Jackson, MO 63755-3042 | 2016-04-26 |
| 1730533738 | Irene Lim Lo Suy Comstock | Occupational Therapist | 710 Broadridge Dr, Jackson, MO 63755-3042 | 2016-04-16 |
| 1538470521 | Judy L Hart | Occupational Therapy Assistant | 710 Broadridge Dr, Jackson, MO 63755-3042 | 2010-06-24 |
| 1447430202 | Richel Pingkian | Occupational Therapist | 710 Broadridge Dr, Jackson, MO 63755 | 2007-11-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942847413 | Southeast Hospital | Pharmacy | 2600 E. Main Street, Suite 113, Jackson, MO 63755 | 2019-12-04 |
| 1215438585 | The Villas of Jackson LLC | Assisted Living Facility | 670 Broadridge, Jackson, MO 63755 | 2018-02-22 |
| 1346637865 | Vitality Clinic | Health Educator | 111 N. Missouri Street, Jackson, MO 63755 | 2015-04-22 |
| 1144569567 | Rock Care In Home Services, LLC | Nursing Care | 204 S Union Ave, Jackson, MO 63755 | 2013-02-05 |
| 1447506381 | Morgan Allyce Strand | Optometrist | 2954 E. Jackson Blvd, Jackson, MO 63755 | 2012-07-30 |
| 1154689321 | Benjamin Gail Goodier | Dentist | 3100 East Jackson Blvd., Jackson, MO 63755 | 2012-04-25 |
| 1912278987 | Guardian Angels Homecare, LLC | Nursing Care | 1335 Old Cape Rd., Suite F, Jackson, MO 63755 | 2012-01-23 |
| 1528357829 | Sydney Nicole Cheek | Technician, Other | 107 Cottonwood St., Jackson, MO 63755 | 2011-04-07 |
| 1215162920 | Troy L Bell Od & Associates, PC | Optometrist | 2594 E Jackson Blvd, Jackson, MO 63755 | 2009-05-26 |
| 1932398021 | Immediate Healthcare, Inc. | General Practice | 1508 Edgemont Blvd, Perryville, MO 63755 | 2007-10-15 |
| Find all providers in zip 63755 | ||||
| Taxonomy Code | 314000000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Skilled Nursing Facility |
| (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. |
| Notes: Source: (1) "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 64; (2) AHA Guide, 1996 Annual Survey. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326348897 | Laurie L. Mcbride | Skilled Nursing Facility | 180 W University Pkwy Ste H, Jackson, TN 38305-1612 | 2010-10-29 |
| 1407179039 | Caring Hands Community Services Inc | Skilled Nursing Facility | 3318 Longwood Drive, Jackson, MS 39212 | 2010-03-10 |
| 1568791804 | North Street Healthcare LLC | Skilled Nursing Facility | 865 North St, Jackson, MS 39202-3020 | 2009-12-16 |
| 1679712665 | West Tennessee Transitional Care Inc | Skilled Nursing Facility | 597 West Forest Ave, Jackson, TN 38301 | 2009-02-13 |
| 1285802652 | Trilogy Healthcare of Jackson, LLC | Skilled Nursing Facility | 703 Robinson Road, Jackson, MI 49203-2538 | 2008-02-19 |
| 1174732333 | Louisiana War Veterans Home | Skilled Nursing Facility | 4739 Highway 10, Jackson, LA 70748 | 2007-05-22 |
| 1760521256 | Omni Visions, Inc | Skilled Nursing Facility | 50 Directors Row, Jackson, TN 38305 | 2007-02-05 |
| 1326197211 | Cottage Grove Nursing Home, Lp | Skilled Nursing Facility | 1116 Forest Ave, Jackson, MS 39206-3216 | 2007-01-09 |
| 1164597688 | Countryside Care Center, Inc. | Skilled Nursing Facility | 2121 Robinson Rd, Jackson, MI 49203-3658 | 2006-11-21 |
| 1073687083 | Chadwick Nursing and Rehabilitation Center, LLC | Skilled Nursing Facility | 1900 Chadwick Dr, Jackson, MS 39204-3406 | 2006-11-20 |
| Find all providers in JACKSON | ||||
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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.