MARDELL JACKSON (NPI# 1598247009) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1598247009 |
| Entity Type | Individual |
| Full Name | MARDELL JACKSON |
| Practice Address |
197 Nw Gwen Lake Ave Lake City FL 32055-3711 |
| Mailing Address |
Po Box 2666 Lake City FL 32056-2666 |
| Practice Telephone | 3866979425 |
| Mailing Telephone | 3866979425 |
| Enumeration Date | 2018-08-30 |
| Last Update Date | 2018-08-30 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 310400000X | Assisted Living Facility | Nursing & Custodial Care Facilities |
| Street Address |
197 NW GWEN LAKE AVE |
| City | LAKE CITY |
| State | FL |
| Zip Code | 32055-3711 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396358792 | Golden Manor Assisted Living Facility LLC | Assisted Living Facility | 197 Nw Gwen Lake Ave, Lake City, FL 32055-3711 | 2020-08-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114439510 | Melissa Fay Peters | Nurse Practitioner | 5085 West Us Highway 90, Lake City, FL 32055 | 2017-10-26 |
| 1851801765 | Stephanie Jo Nogle | Occupational Therapist | Brooks Americare: 4251 Nw American Ln, #103, Lake City, FL 32055 | 2017-10-05 |
| 1831617273 | Erica Mayo | Pharmacist | 4846 Nw Lake Jeffery Rd., Lake City, FL 32055 | 2017-09-06 |
| 1144759333 | Jerry Hamilton Cheesman | Dentist | 217 Ne Franklin Sreet, Lake City, FL 32055 | 2017-06-09 |
| 1487183745 | Joshua Allore | Dentist | 2970 W Us Highway 90., Lake City, FL 32055 | 2017-06-08 |
| 1497298418 | Careing Hands | Preferred Provider Organization | 1471nw Queen Rd, Lakecity, FL 32055 | 2016-11-22 |
| 1881148278 | Corniqueca Stewart-simmons | Nurse Practitioner | 340 Nw Commerce Drive, Lake City, FL 32055 | 2016-08-15 |
| 1164809141 | Latasha Harten-jones | Licensed Practical Nurse | 443 Ne Sims Dr, Lake City, FL 32055 | 2015-04-29 |
| 1154716447 | Lindsey Morton | Counselor | 219 Se Baya Avenue, Lake City, FL 32055 | 2015-04-02 |
| 1124439351 | Tynette Jordan | Counselor | 708 N.w Wilson St., Lake City, FL 32055 | 2014-05-09 |
| Find all providers in zip 32055 | ||||
| Taxonomy Code | 310400000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235745753 | Shenay Fulton | Assisted Living Facility | 536 Nw Shelby Ter, Lake City, FL 32055-3280 | 2020-09-21 |
| 1265071153 | Serenity Hill Assisted Living Facility | Assisted Living Facility | 3534 230th Ter, Lake City, FL 32024-2714 | 2019-12-25 |
| 1902447527 | Harper Lake Operations, LLC | Assisted Living Facility | 213 Nw Gleason Dr, Lake City, FL 32055-5846 | 2019-10-04 |
| 1114420502 | Ets Willowbrook At Marion | Assisted Living Facility | 1580 S Marion Ave, Lake City, FL 32025-6913 | 2018-03-13 |
| 1306249149 | Mercy Home Assisted Living Facility LLC | Assisted Living Facility | 184 S.e. Beech Street, Lake City, FL 32025 | 2014-10-08 |
| 1467878454 | Hendrix, Smith, & Kirby LLC D/b/a Eastside Care Alf | Assisted Living Facility | 152 Se Defender Dr, Lake City, FL 32025-4990 | 2014-03-14 |
| 1881010072 | Summers Assisted Living Facility | Assisted Living Facility | 1225 Sw Grandview St, Lake City, FL 32025-0740 | 2014-03-12 |
| 1366866097 | Clara Ferguson I | Assisted Living Facility | 184 Se Beech St, Lake City, FL 32025-4982 | 2014-02-17 |
| 1417383241 | The Plantation On Summers LLC | Assisted Living Facility | 147 Sw Summers Ln, Lake City, FL 32025-0762 | 2013-09-25 |
| 1417392150 | Douglas Assisted Living Facility | Assisted Living Facility | 769 Ne Gurley Ave, Lake City, FL 32055-2453 | 2013-05-08 |
| Find all providers in LAKE CITY | ||||
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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.