CAROLYN LOUISE JACKSON (NPI# 1568972065) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1568972065 |
| Entity Type | Individual |
| Full Name | CAROLYN LOUISE JACKSON |
| Practice Address |
6666 Green Valley Cir Culver City CA 90230-7068 |
| Practice Telephone | 3108465270 |
| Practice Fax Number | 3108465278 |
| Mailing Telephone | 3108465270 |
| Mailing Fax Number | 3108465278 |
| Enumeration Date | 2017-10-10 |
| Last Update Date | 2017-10-10 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 171M00000X | Case Manager/Care Coordinator | Other Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417428251 | Carolyn Jackson | Registered Nurse | 12502 Beauline Abbey St, Tomball, TX 77377-9017 | 2018-12-05 |
| 1407223233 | Carolyn Jackson | Dietitian, Registered | 1139 Yale Pl, Charlotte, NC 28209-1437 | 2015-08-27 |
| 1750779187 | Carolyn E Jackson | Physical Therapist | 737 Se Main St, Ste 200, Simpsonville, SC 29681-3262 | 2015-01-08 |
| 1386984284 | Carolyn Ann Jackson | Registered Nurse | 926 Perry Ave, Dillon, SC 29536-4734 | 2013-03-01 |
| 1689805657 | Carolyn Denise Jackson | Counselor | 3205 Randall Pkwy Ste 121, Wilmington, NC 28403 | 2009-08-07 |
| 1356453591 | Carolyn Marie Jackson | Social Worker | 380 E Fort Lowell Rd Ste 120, Tucson, AZ 85705-3981 | 2006-08-31 |
| 1023063823 | Carolyn A Jackson | Nurse Practitioner | 37984 Airport Rd, Woodsfield, OH 43793-9247 | 2006-05-23 |
| 1740723972 | Carolyn Jackson | In Home Supportive Care | 301 Main St Ste 2200, Baton Rouge, LA 70801-0014 | 2016-11-20 |
| 1821460742 | Carolyn Jackson | Social Worker | 11616 Southfork Ave, Baton Rouge, LA 70816-5241 | 2015-10-30 |
| 1780074294 | Carolyn Anece Jackson | Occupational Therapist | 2450 Riverside Ave, R102, Minneapolis, MN 55454-1450 | 2015-02-04 |
| Street Address |
6666 GREEN VALLEY CIR |
| City | CULVER CITY |
| State | CA |
| Zip Code | 90230-7068 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932228095 | Mary Kate Mccauley | Case Manager/Care Coordinator | 6666 Green Valley Cir, Culver City, CA 90230-7068 | 2007-03-28 |
| 1700486735 | Ethan Luke Mcmurray | Case Manager/Care Coordinator | 6666 Green Valley Cir, Culver City, CA 90230-7068 | 2020-10-28 |
| 1801493119 | Justin John Hicks | Case Manager/Care Coordinator | 6666 Green Valley Cir, Culver City, CA 90230-7068 | 2020-10-08 |
| 1053926832 | Brent Andrew Owen | Case Manager/Care Coordinator | 6666 Green Valley Cir, Culver City, CA 90230-7068 | 2020-09-09 |
| 1548879927 | Ali Azad | Case Manager/Care Coordinator | 6666 Green Valley Cir, Culver City, CA 90230-7068 | 2020-07-30 |
| 1780202523 | Kevin Christopher Gleason | Case Manager/Care Coordinator | 6666 Green Valley Cir, Culver City, CA 90230-7068 | 2020-07-08 |
| 1427675123 | Bojidar Todorov Marinov | Case Manager/Care Coordinator | 6666 Green Valley Cir, Culver City, CA 90230-7068 | 2020-06-29 |
| 1568097582 | Ashley Donaldson | Case Manager/Care Coordinator | 6666 Green Valley Cir, Culver City, CA 90230-7068 | 2020-03-10 |
| 1609401793 | Anthony Alan Freitas | Case Manager/Care Coordinator | 6666 Green Valley Cir, Culver City, CA 90230-7068 | 2020-03-09 |
| 1902431000 | Bryan Thomas Harrison | Case Manager/Care Coordinator | 6666 Green Valley Cir, Culver City, CA 90230-7068 | 2020-03-09 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558822064 | Smilemax Dental Center | Dentist | 10814 Jefferson Blvd. #g, Culver City, CA 90230 | 2019-03-27 |
| 1023532595 | Mary Alice Haye | Marriage & Family Therapist | 550 S. Vermont Ave., 7th Floor, 700, Los Angeles, CA 90230 | 2017-07-27 |
| 1902342074 | Dorene Lehavi | Social Worker | 5106 S Slauson Ave, Suite 192, Los Angeles, CA 90230 | 2017-01-13 |
| 1548634553 | Kimberly Henck | Speech-Language Pathologist | 607 Bristol Pkwy, Ste 105, Culver City, CA 90230 | 2015-11-15 |
| 1346628898 | Stephan Sepernia | Marriage & Family Therapist | 5601 W. Slavson Ave. #192, Culver City, CA 90230 | 2015-05-15 |
| 1558749291 | Sean Steven Mcknee | Chiropractor | 5839 Green Valley Cir Ste 102, Culver City, CA 90230 | 2015-05-14 |
| 1821484841 | Jasmine Lee | Family Medicine | 6000 Sepulveda Blvd Ste E10, Culver City, CA 90230 | 2015-04-07 |
| 1043609191 | Carrie Mays | Counselor | 4760 Sepulvda Blvd., Culver City, CA 90230 | 2015-01-13 |
| 1457759375 | Monquenta Felicia Young | Case Manager/Care Coordinator | 666 Green Valley Circle, Culver City, CA 90230 | 2014-12-09 |
| 1972902724 | Shana Chan Pope | Marriage & Family Therapist | 11949 Jefferson Blvd #106, Culver City, CA 90230 | 2014-08-18 |
| Find all providers in zip 90230 | ||||
| Taxonomy Code | 171M00000X |
| Grouping | Other Service Providers |
| Classification | Case Manager/Care Coordinator |
| A person who provides case management services and assists an individual in gaining access to needed medical, social, educational, and/or other services. The person has the ability to provide an assessment and review of completed plan of care on a periodic basis. This person is also able to take collaborative action to coordinate the services with other providers and monitor the enrollee’s progress toward the cost-effective achievement of objectives specified in the plan of care. Credentials may vary from an experience in the fields of psychology, social work, rehabilitation, nursing or a closely related human service field, to a related Assoc of Arts Degree or to nursing credentials. Some states may require certification in case management. |
| Notes: Source: CMS State Medicaid Manual Section 4442.3 [7/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457759375 | Monquenta Felicia Young | Case Manager/Care Coordinator | 666 Green Valley Circle, Culver City, CA 90230 | 2014-12-09 |
| 1780878249 | Kiyatana Sapp | Case Manager/Care Coordinator | 4760 South Sepulveda Blvd., Culver City, CA 90230 | 2007-08-28 |
| 1851502520 | Elizabeth G Hartigan | Case Manager/Care Coordinator | 6666 Green Valley Circle, Culver City, CA 90230-7068 | 2007-05-24 |
| 1932228095 | Mary Kate Mccauley | Case Manager/Care Coordinator | 6666 Green Valley Cir, Culver City, CA 90230-7068 | 2007-03-28 |
| 1700486735 | Ethan Luke Mcmurray | Case Manager/Care Coordinator | 6666 Green Valley Cir, Culver City, CA 90230-7068 | 2020-10-28 |
| 1801493119 | Justin John Hicks | Case Manager/Care Coordinator | 6666 Green Valley Cir, Culver City, CA 90230-7068 | 2020-10-08 |
| 1053926832 | Brent Andrew Owen | Case Manager/Care Coordinator | 6666 Green Valley Cir, Culver City, CA 90230-7068 | 2020-09-09 |
| 1548879927 | Ali Azad | Case Manager/Care Coordinator | 6666 Green Valley Cir, Culver City, CA 90230-7068 | 2020-07-30 |
| 1780202523 | Kevin Christopher Gleason | Case Manager/Care Coordinator | 6666 Green Valley Cir, Culver City, CA 90230-7068 | 2020-07-08 |
| 1427675123 | Bojidar Todorov Marinov | Case Manager/Care Coordinator | 6666 Green Valley Cir, Culver City, CA 90230-7068 | 2020-06-29 |
| Find all providers in CULVER CITY | ||||
| City | CULVER CITY |
| Zip Code | 90230 |
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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.