Jerome Alexander-Terrell Jackson
Foster Care Agency in Peoria, AZ. Individual provider (NPI-1).
NPI number1740815497
StatusActive
Last updated in NPPESMar 3, 2020
Details
- NPI
- 1740815497
- Entity type
- Individual (NPI-1)
- Name
- Jerome Alexander-Terrell Jackson
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Mar 3, 2020
- Certification date
- Mar 3, 2020
- Last updated
- Mar 3, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 253J00000X | Foster Care Agency | 10195508 | AZ | Yes |
| 385HR2055X | Respite Care, Respite Care, Mental Illness, Child | 10195508 | AZ |
Practice location
9680 W Northern Ave Unit 2311Peoria, AZ 85345-4655
Phone 989-980-8286 · Fax 602-455-4626
Mailing address
9680 W Northern Ave Unit 2311Peoria, AZ 85345-4655
Phone 989-980-8286 · Fax 602-455-4626
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