JACKSON RECOVERY CENTERS, INC. (NPI# 1649603283) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649603283 |
| Entity Type | Organization |
| Organization Name | JACKSON RECOVERY CENTERS, INC. |
| Other Organization Name | ADOLESCENT CENTER |
| Practice Address |
2101 Court St Sioux City IA 51104-3243 |
| Mailing Address |
800 5th St Sioux City IA 51101-1317 |
| Practice Telephone | 7122934912 |
| Practice Fax Number | 7122934804 |
| Mailing Telephone | 7122342300 |
| Mailing Fax Number | 7122342398 |
| Enumeration Date | 2013-08-19 |
| Last Update Date | 2013-08-19 |
| Authorized Official Name | MR. KERMIT DAHLEN (CEO/PRESIDENT) |
| Authorized Official Telephone | 7122342300 |
| Is Organization Subpart | Y |
| Parent Organization Name | JACKSON RECOVERY CENTERS, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 324500000X | Substance Abuse Rehabilitation Facility | 1237 | IA | Residential Treatment Facilities |
| Other Name | Type Code |
|---|---|
| Adolescent Center | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770966491 | Jackson Recovery Centers, Inc. | Substance Abuse Rehabilitation Facility | 3500 West 4th Street, Sioux City, IA 51103 | 2015-06-30 |
| 1811994973 | Jackson Recovery Centers, Inc. | Voluntary or Charitable | 800 5th St, Suite 200, Sioux City, IA 51101-1317 | 2005-07-05 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Iowa Business Entities | JACKSON RECOVERY CENTERS, INC. | 800 5th Street, Suite 200, Sioux City, IA 51101 |
| Street Address |
2101 COURT ST |
| City | SIOUX CITY |
| State | IA |
| Zip Code | 51104-3243 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003877291 | Kimberly Joan Devries | Social Worker | 2101 Court St, Sioux City, IA 51104-3243 | 2006-03-29 |
| 1255825816 | Laura Ann Mcardle | Counselor | 2101 Court St, Sioux City, IA 51104-3243 | 2018-06-18 |
| 1154852531 | Amy Small | Counselor | 2101 Court St, Sioux City, IA 51104-3243 | 2017-03-27 |
| 1104357599 | Tiffany Holbrook | Counselor | 2101 Court St, Sioux City, IA 51104-3243 | 2017-03-27 |
| 1700334083 | Brianna Mae Peterson | Counselor | 2101 Court St, Sioux City, IA 51104-3243 | 2016-09-15 |
| 1598132110 | Christina M Spicer | Counselor | 2101 Court St, Sioux City, IA 51104-3243 | 2015-08-31 |
| 1205052420 | Bradley J Bergeson | Counselor | 2101 Court St, Sioux City, IA 51104-3243 | 2007-04-17 |
| 1689716169 | Dean Watchorn Newbrey | Social Worker | 2101 Court St, Sioux City, IA 51104-3243 | 2007-02-13 |
| 1235271305 | Family Service's Inc | Clinic/Center | 2101 Court St, Sioux City, IA 51104-3243 | 2007-02-13 |
| 1184701245 | Boys and Girls Home and Family Services, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 2101 Court St, Sioux City, IA 51104-3243 | 2006-11-01 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578944435 | Family First Dental Associates of Iowa, P.C. | Dentist | 2100 Indian Hills Drive, Sioux City, IA 51104 | 2015-06-16 |
| 1740590785 | Khatu Vivienne Erlbacher | Pharmacist | 515 North Briar Path, Sioux City, IA 51104 | 2010-10-08 |
| 1730407545 | Randall Glen Wood | Emergency Medicine | 2720 Stone Park Blvd., Sioux City, IA 51104 | 2010-05-04 |
| 1790811024 | Fred R Rizk | Dentist | 1923 Nebraska Street, Siuox City, IA 51104 | 2007-02-23 |
| 1255474029 | Edilia Maria Marshall | Dentist | Summit Dental, 2114 Pierce St, Sioux City, IA 51104 | 2007-02-14 |
| 1063553410 | Thomas Leonard Tiedeman | Dentist | 2918 Hamilton Blvd, Upper D Suite 1, Sioux City, IA 51104 | 2007-02-09 |
| 1336209188 | Shawn Robert Walton | Dentist | 2410 Pierce Street, Sioux City, IA 51104 | 2006-12-11 |
| 1477649556 | Timothy R Kuntz | Dentist | 3012 Hamilton Blvd, Sioux City, IA 51104 | 2006-10-05 |
| 1528162732 | Duane Kent Nelson | Orthopaedic Surgery | 2800 Peirce St, Suite 101, Sioux City, IA 51104 | 2006-09-08 |
| 1659482206 | Shawn R Walton | Dentist | 2928 Hamilton Blvd, Suite 102, Sioux City, IA 51104 | 2006-08-31 |
| Find all providers in zip 51104 | ||||
| Taxonomy Code | 324500000X |
| Grouping | Residential Treatment Facilities |
| Classification | Substance Abuse Rehabilitation Facility |
| A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. |
| Notes: [7/1/2003: modified title, modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275032443 | Morgan P Foley | Substance Abuse Rehabilitation Facility | 2030 Keokuk St, Iowa City, IA 52240-4456 | 2018-02-02 |
| 1629525308 | St. Gregory Recovery Center, LLC | Substance Abuse Rehabilitation Facility | 1985 Ne 51st Pl, Des Moines, IA 50313-2517 | 2016-09-09 |
| 1477974244 | House of Mercy | Substance Abuse Rehabilitation Facility | 511 E 21st St S, Newton, IA 50208-5104 | 2013-12-23 |
| 1750511143 | St Gregory Centers, Inc | Substance Abuse Rehabilitation Facility | 5875 Fleur Dr, Des Moines, IA 50321-2883 | 2009-07-20 |
| 1568609360 | The Abbey | Substance Abuse Rehabilitation Facility | 1401 Central Ave, Bettendorf, IA 52722-6034 | 2009-01-15 |
| 1386810646 | Alcohol & Drug Dependency Services | Substance Abuse Rehabilitation Facility | 928 Main St, Keokuk, IA 52632-4655 | 2008-05-06 |
| 1043486400 | Alcohol & Drug Dependency Services | Substance Abuse Rehabilitation Facility | 304 Highway 61 N, Wapello, IA 52653-1243 | 2008-05-06 |
| 1174723118 | Fort Dodge Ywca Women's Halfway House | Substance Abuse Rehabilitation Facility | 826 1st Ave N, Fort Dodge, IA 50501-3906 | 2007-07-18 |
| 1871641159 | Clearview Recovery, Inc. | Substance Abuse Rehabilitation Facility | 501 N Sherman St, Prairie City, IA 50228-8666 | 2007-01-05 |
| 1801952205 | Resolutions Substance Abuse Services | Substance Abuse Rehabilitation Facility | 220 Lafayette St, Iowa City, IA 52240-1746 | 2006-12-29 |
| Find all providers with the same taxonomy | ||||
| City | SIOUX CITY |
| Zip Code | 51104 |
Please comment or provide details below to improve the information on JACKSON RECOVERY CENTERS, INC..
| 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.