ITELYA JACKSON (NPI# 1811352412) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811352412 |
| Entity Type | Individual |
| Full Name | ITELYA JACKSON |
| Credential | RN |
| Practice Address |
6957 Pine Shadow Way Winston GA 30187-2150 |
| Mailing Address |
8491 Hospital Dr # 135 Douglasville GA 30134-2412 |
| Practice Telephone | 6785404446 |
| Practice Fax Number | 6785404426 |
| Mailing Telephone | 6785404446 |
| Mailing Fax Number | 6785404426 |
| Enumeration Date | 2015-12-23 |
| Last Update Date | 2015-12-23 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 253Z00000X | In Home Supportive Care | Agencies |
| Street Address |
6957 PINE SHADOW WAY |
| City | WINSTON |
| State | GA |
| Zip Code | 30187-2150 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093175689 | Ilive Home Care Services | In Home Supportive Care | 6957 Pine Shadow Way, Winston, GA 30187-2150 | 2016-02-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982836581 | United Medical Response LLC | Ambulance | 2425 Jason Industrial Pkwy, Winston, GA 30187 | 2009-08-14 |
| 1598275745 | Maple Clinic for Speech and Language LLC | Speech-Language Pathologist | 7824 Tyree Rd, Winston, GA 30187-1230 | 2017-10-02 |
| 1477063600 | Kelly Gawel | Speech-Language Pathologist | 7824 Tyree Rd, Winston, GA 30187-1230 | 2017-10-02 |
| 1114430097 | Richard Anthony Bell II | Registered Nurse | 7940 Hannah Rd, Winston, GA 30187-1237 | 2017-11-14 |
| 1356509376 | Foroogh Elguindi | Counselor | 5123 Daniell Mill Road, Winston, GA 30187-1362 | 2008-05-27 |
| 1912147539 | Reginald Gary Woodell | Dentist | 7571 Highway 78, Winston, GA 30187-1449 | 2009-02-22 |
| 1588214100 | Patricia Wynn | Contractor | 6822 Cowan Mill Rd, Winston, GA 30187-1533 | 2019-09-16 |
| 1336534924 | Leondria Taty | Nurse Practitioner | 2929 Post Rd, Winston, GA 30187-1537 | 2015-04-01 |
| 1841651254 | Amelia St John | Registered Nurse | 3644 Mason Ridge Dr, Winston, GA 30187-1578 | 2016-03-11 |
| 1952879017 | Deborah Jones | Social Worker | 3599 Falls Trl, Winston, GA 30187-1595 | 2018-11-07 |
| Find all providers in zip 30187 | ||||
| Taxonomy Code | 253Z00000X |
| Grouping | Agencies |
| Classification | In Home Supportive Care |
| An In Home Supportive Care Agency provides services in the patient’s home with the goal of enabling the patient to remain at home. The services provided may include personal care services such as hands-on assistance with activities of daily living (ADLs), e.g., eating, bathing, dressing, and bladder and bowel requirements; homemaker services and instrumental activities of daily living (IADLs), e.g., taking medications, shopping for groceries, laundry, housekeeping, and companionship; and/or supervision or cuing so that a person can perform tasks themselves. |
| Notes: Source: National Uniform Claim Committee, 2008 [7/1/2008: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710377031 | Blessed Assurance Nursing and In Home Services Inc. | In Home Supportive Care | 3329 Franklin Forest Dr, Winston, GA 30187-2108 | 2015-01-24 |
| 1093175689 | Ilive Home Care Services | In Home Supportive Care | 6957 Pine Shadow Way, Winston, GA 30187-2150 | 2016-02-25 |
| 1851781124 | Blessed Assurance Nursing and In Home Services Inc. | In Home Supportive Care | 3329 Franklin Forest Dr, Winston, GA 30187-2108 | 2015-01-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336740356 | Charlies Angels Care Corp | In Home Supportive Care | 525 W Broad St, Twin City, GA 30471-4187 | 2020-11-05 |
| 1316547433 | Xl Promise Home Care LLC | In Home Supportive Care | 102 Highland Park Trl, Sandy Springs, GA 30350-3392 | 2020-10-28 |
| 1639779960 | Caring House Home Care Services, LLC | In Home Supportive Care | 1100 Pittsburgh Ave, White Plains, GA 30678 | 2020-10-27 |
| 1518565159 | First Choice Home Health Care LLC | In Home Supportive Care | 600 Westridge Parkway, Suite 707, Mcdonough, GA 30253 | 2020-10-15 |
| 1871100123 | Angella Miller | In Home Supportive Care | 326 Carrington Ln, Douglasville, GA 30135-6712 | 2020-09-29 |
| 1366059222 | Esther Home Care Services LLC | In Home Supportive Care | 3153 Chapel Rd Nw, Kennesaw, GA 30144-4203 | 2020-09-25 |
| 1538776570 | Superior Home Care Services, LLC | In Home Supportive Care | 2242 Young America Dr, Lawrenceville, GA 30043-8011 | 2020-09-24 |
| 1548876816 | Dwe-bah Home Care LLC. | In Home Supportive Care | 1991 Roxey Ln, Winder, GA 30680-6124 | 2020-09-21 |
| 1174138416 | Crossley Seniorcare LLC | In Home Supportive Care | 4321 S Lee St Ste 400, Buford, GA 30518-5776 | 2020-09-14 |
| 1427662634 | V E Health Services LLC | In Home Supportive Care | 3164 Town and Country Road, Donalsonville, GA 39845 | 2020-09-04 |
| 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.