SHIRLEY MCMILLAN JACKSON (NPI# 1063838878) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063838878 |
| Entity Type | Individual |
| Full Name | SHIRLEY MCMILLAN JACKSON |
| Practice Address |
2117 Luckner Ct Mobile AL 36618-2618 |
| Mailing Address |
410 S Wilson Ave Prichard AL 36610-3910 |
| Practice Telephone | 2514238197 |
| Practice Fax Number | 2514524797 |
| Mailing Telephone | 2514231897 |
| Mailing Fax Number | 2514524797 |
| Enumeration Date | 2014-03-17 |
| Last Update Date | 2014-03-17 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320900000X | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | Residential Treatment Facilities |
| Street Address |
2117 LUCKNER CT |
| City | MOBILE |
| State | AL |
| Zip Code | 36618-2618 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700205705 | Exclusive Residential Service LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 2117 Luckner Ct, Mobile, AL 36618-2618 | 2014-04-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114319944 | Gina Deering | Pharmacist | 5651 Moffett Rd, Suite C, Mobile, AL 36618 | 2015-03-03 |
| 1245510403 | Thuy-ngan Thi Duong | Pharmacist | 5651 Moffett Road, Mobile, AL 36618 | 2011-08-19 |
| 1679852586 | Innovative Prosthetic Care, LLC | Prosthetic/Orthotic Supplier | 1109 Wi-65 Service Rd N, Mobile, AL 36618 | 2011-08-09 |
| 1649454695 | Louis James Naman | Dentist | 4137 Moffelt Rd., Mobile, AL 36618 | 2007-12-27 |
| 1235254277 | Amie G Webb | Pharmacist | 5651 C Moffat Rd, Mobile, AL 36618 | 2007-03-20 |
| 1659431682 | Gerald Edward Berger | Dentist | 5216 Overlook Road, Mobile, AL 36618 | 2006-12-11 |
| 1780779314 | Tammy Dubuc | Pharmacist | 5651 C Moffet Road, Mobile, AL 36618 | 2006-10-03 |
| 1245330711 | Dana B Lambert | Pharmacist | 5651-c Moffet Rd Winn Dixie 578, Mobile, AL 36618 | 2006-09-25 |
| 1861444689 | Michael Carl Madden Sr. | Family Medicine | 7505 Moffett Rd, Mobile, AL 36618 | 2006-05-17 |
| 1518518968 | Daniel Loper | Clinical Medical Laboratory | 3750 Moffett Rd, Mobile, AL 36618-1208 | 2019-09-26 |
| Find all providers in zip 36618 | ||||
| Taxonomy Code | 320900000X |
| Grouping | Residential Treatment Facilities |
| Classification | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
| A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972021970 | Volunteers of America Southeast | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1204 Hillcrest Rd, Mobile, AL 36695-3930 | 2017-08-30 |
| 1851813422 | Ericka Letoindia Betton | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1554 Basil St, Mobile, AL 36603-5019 | 2017-07-14 |
| 1275945149 | George Lee Love | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 13321 August Dr, Mobile, AL 36695-8595 | 2014-05-27 |
| 1477975936 | Prestige Supervised Community Living Inc | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1725 Northview Dr, Mobile, AL 36618-1801 | 2014-01-16 |
| 1992090666 | Robinson's Residential, Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 4954 Ringold Dr S, Mobile, AL 36693-3678 | 2011-06-10 |
| 1871885517 | Lifetime Healthcare Incorporated | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 2201 Robinson Dr, Mobile, AL 36605-5137 | 2011-05-13 |
| 1518280668 | Northview Health Services, L.l.c | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1640 Northview Dr, Mobile, AL 36618-1804 | 2010-03-03 |
| 1063549103 | Parker Adult Foster Home, Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 671 Stanton Rd, Mobile, AL 36617-2205 | 2007-02-27 |
| 1952437493 | Nobles Group Homes, Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 2420 S Shelton Beach Rd, Mobile, AL 36613-3415 | 2007-02-27 |
| 1932252350 | Scott Residential, Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 115 N Catherine St, Mobile, AL 36604-1303 | 2007-01-19 |
| Find all providers in MOBILE | ||||
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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.