DEBORAH JACKSON


Address: 1100 W 6th Ave, Gary, IN 46402
Phone: 2198854264

DEBORAH JACKSON (NPI# 1801254461) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1801254461
Entity Type Individual
Full Name DEBORAH JACKSON
Practice Address 1100 W 6th Ave
Gary
IN 46402
Mailing Address 1100 W 5th Ave
Gary
IN 46402
Practice Telephone 2198854264
Mailing Telephone 2198854264
Enumeration Date 2016-02-10
Last Update Date 2016-02-10
Gender Code F
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 320800000X Community Based Residential Treatment Facility, Mental Illness Residential Treatment Facilities

Other Providers DEBORAH JACKSON

NPI Name Taxonomy Address Enumeration
1891249777 Deborah Dobey Jackson Licensed Practical Nurse 4095 Country Club Rd, Spartanburg, SC 29302-4458 2016-08-09
1144680018 Deborah Jackson Counselor 17 Hamilton Avenue, Monticello, NY 12701 2016-03-04
1780080929 Deborah Jackson Occupational Therapy Assistant 280 Pine Forest Dr, Lawrenceville, GA 30046-6032 2014-11-17
1336107408 Deborah A Jackson Physical Therapist 319 W Town Pl, Suite 5, St Augustine, FL 32092-3101 2006-05-01
1730738469 Deborah L Jackson Technician 1510 Fort Davis Pl Se, Washington, DC 20020-6028 2019-09-05
1174051114 Deborah Jackson Registered Nurse 405 Avenue of The States, Chester, PA 19013-4403 2017-06-02
1073057279 Deborah Jackson Nurse Practitioner 2900 E University Dr Ste 110, Auburn, AL 36830-7729 2016-12-07
1740737485 Deborah Jackson Community Health Worker 1010 Common St Ste 500, New Orleans, LA 70112-2467 2016-09-09
1316399090 Deborah Jackson Counselor 2212 Devine St Ste D, Columbia, SC 29205-2402 2016-07-06
1245624535 Deborah Jackson Counselor 401 Pilgrim Ln, Drexel Hill, PA 19026-5000 2015-03-24

Office Location

Street Address 1100 W 6TH AVE
City GARY
State IN
Zip Code 46402

Providers in the same location

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

Providers in the same zip code

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 Information

Taxonomy Code 320800000X
Grouping Residential Treatment Facilities
Classification Community Based Residential Treatment Facility, Mental Illness

Taxonomy Definition

A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness.
Notes: [7/1/2003: new]

Providers in the same taxonomy and city

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

Competitor

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City GARY
Zip Code 46402

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Dataset Information

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.

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