BEVERLY JACKSON (NPI# 1871902247) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871902247 |
| Entity Type | Individual |
| Full Name | BEVERLY JACKSON |
| Practice Address |
1100 W 6th Ave Gary IN 46402-1711 |
| Practice Telephone | 2198854264 |
| Mailing Telephone | 2198854264 |
| Enumeration Date | 2014-08-10 |
| Last Update Date | 2014-08-10 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320800000X | Community Based Residential Treatment Facility, Mental Illness | Residential Treatment Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134608391 | Beverly J Jackson | Registered Nurse | 817 Briarcreek Dr, Baytown, TX 77521-3473 | 2018-08-08 |
| 1023548591 | Beverly Jackson | Nurse Practitioner | 608 Pine Pass Circle, Mineral Bluff, GA 30559 | 2017-06-15 |
| 1336465913 | Beverly P Jackson | Nutritionist | 19 Silk St, Norwalk, CT 06850-2916 | 2010-04-08 |
| 1891263125 | Beverly Jackson | Speech-Language Pathologist | 4511 Bestor Dr, Rockville, MD 20853-2100 | 2018-11-05 |
| 1154898468 | Beverly Jackson | Case Manager/Care Coordinator | 2017 Hudson Ln, Monroe, LA 71201-5705 | 2018-10-25 |
| 1477814424 | Beverly Yvonne Jackson | Registered Nurse | 4212 N 16th St, Phoenix, AZ 85016-5319 | 2012-06-06 |
| 1891052619 | Beverly L Jackson | Occupational Therapist | 1860 Pennsylvania Ave, Mcdonough, GA 30253-9117 | 2012-04-18 |
| 1245507813 | Beverly High Jackson | Pharmacist | 2950 S Blue Angel Pkwy, Pensacola, FL 32506-6905 | 2011-11-25 |
| 1750606539 | Beverly Anne Jackson | Counselor | 77 Cortland Ave, San Francisco, CA 94110-5435 | 2010-04-05 |
| 1134254618 | Beverly Jackson | Nurse Practitioner | 2065 Herschel St, Jacksonville, FL 32204-3817 | 2007-02-23 |
| Street Address |
1100 W 6TH AVE |
| City | GARY |
| State | IN |
| Zip Code | 46402-1711 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912970229 | Mathew V Castelino | Psychiatry & Neurology | 1100 W 6th Ave, Gary, IN 46402-1711 | 2006-02-08 |
| 1578162087 | Laura Lisseth Robles | Technician, Other | 1100 W 6th Ave, Gary, IN 46402-1711 | 2020-10-26 |
| 1013516939 | Laresse Harris | Nurse Practitioner | 1100 W 6th Ave, Gary, IN 46402-1711 | 2020-10-21 |
| 1245838762 | Alexis Katherine Neylon | Technician, Other | 1100 W 6th Ave, Gary, IN 46402-1711 | 2020-10-16 |
| 1386242378 | Ameena R Rucker | Case Manager/Care Coordinator | 1100 W 6th Ave, Gary, IN 46402-1711 | 2020-10-13 |
| 1215535372 | Brittany Marie Comer | Specialist/Technologist | 1100 W 6th Ave, Gary, IN 46402-1711 | 2020-10-12 |
| 1093321549 | Curtis Freeman | Case Manager/Care Coordinator | 1100 W 6th Ave, Gary, IN 46402-1711 | 2020-09-21 |
| 1174136980 | Shania Johnson | Technician | 1100 W 6th Ave, Gary, IN 46402-1711 | 2020-08-31 |
| 1669080248 | Syreeta Newsom | Technician | 1100 W 6th Ave, Gary, IN 46402-1711 | 2020-07-20 |
| 1841808433 | Andrea W Johnson | Technician | 1100 W 6th Ave, Gary, IN 46402-1711 | 2020-07-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790154417 | Edgewater Systerms for Balanced Living | Community/Behavioral Health | 1106 West 6 Th Avenue, Gary, IN 46402 | 2015-09-23 |
| 1447642772 | Michael Pirtle | Counselor | 1100 W. Fifth Ave, Gary, IN 46402 | 2015-02-24 |
| 1356748370 | Peter F Uchman | Social Worker | 1100 W. 6th Ave., Gary, IN 46402 | 2014-11-20 |
| 1295142594 | Demetria A Macon | Counselor | 1100 W. 6th Ave, Gary, IN 46402 | 2014-07-18 |
| 1396952503 | 21st Century Charter School At Gary | Local Education Agency (LEA) | 556 W Washington, Gary, IN 46402 | 2007-05-17 |
| 1609094630 | Jomon Mathew | Physical Therapist | 353 Tyler St, Gary, IN 46402 | 2007-04-23 |
| 1376677138 | Kovilparambil Xavier Antony | Psychiatry & Neurology | 1100 W 6th Avenue, Gary, IN 46402 | 2007-03-15 |
| 1588759013 | Waltee Douglas | Psychologist | 667 Van Buren, Gary, IN 46402 | 2006-10-03 |
| 1851332514 | Thessa Grace Robertson | Emergency Medicine | 600 Grant Street, Gary, IN 46402 | 2006-06-10 |
| 1932672888 | The Methodist Hospitals, Inc | Pharmacy | 600 Grant St, Gary, IN 46402 | 2019-01-03 |
| Find all providers in zip 46402 | ||||
| Taxonomy Code | 320800000X |
| Grouping | Residential Treatment Facilities |
| Classification | Community Based Residential Treatment Facility, Mental Illness |
| A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346630118 | Renita Ware | Community Based Residential Treatment Facility, Mental Illness | 1003 Colfax St, Gary, IN 46406-1903 | 2015-01-30 |
| 1841609641 | Yvonne Williams | Community Based Residential Treatment Facility, Mental Illness | 444 Fillmore St, Gary, IN 46402-1036 | 2014-08-05 |
| 1235695206 | Sharon Maggie Kelly | Community Based Residential Treatment Facility, Mental Illness | 4747 W 24th Ave, Gary, IN 46406-2821 | 2019-02-14 |
| 1285086561 | Megan Ballard | Community Based Residential Treatment Facility, Mental Illness | 1100 W 6th Ave, Gary, IN 46402-1711 | 2016-07-11 |
| 1922456896 | Rosalind Pirtle | Community Based Residential Treatment Facility, Mental Illness | 1100 W 6th Ave, Gary, IN 46402-1711 | 2016-06-01 |
| 1497103360 | Gene George | Community Based Residential Treatment Facility, Mental Illness | 1100 W 6th Ave, Gary, IN 46402-1711 | 2016-06-01 |
| 1427410216 | Keith Artison | Community Based Residential Treatment Facility, Mental Illness | 1100 W 6th Ave, Gary, IN 46402-1711 | 2016-03-22 |
| 1861854655 | Ella Johnson | Community Based Residential Treatment Facility, Mental Illness | 1100 W 6th Ave, Gary, IN 46402-1711 | 2016-03-22 |
| 1679935399 | Jennifer Sykes | Community Based Residential Treatment Facility, Mental Illness | 1100 W 6th Ave, Gary, IN 46402-1711 | 2016-03-22 |
| 1922460716 | Nika Pickens | Community Based Residential Treatment Facility, Mental Illness | 1100 W 6th Ave, Gary, IN 46402-1711 | 2016-03-22 |
| Find all providers in GARY | ||||
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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.