JEROME ALEXANDER-TERRELL JACKSON NPI 1740815497

NPI Information

NPI: 1740815497
Provider Name: JEROME ALEXANDER-TERRELL JACKSON
Classification: Foster Care Agency - 253J00000X
Entity Type: Individual
Address:
9680 W NORTHERN AVE UNIT 2311
PEORIA, AZ
ZIP 85345
Phone: (989) 980-8286
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Jerome Alexander-terrell Jackson is a foster care agency in Peoria, AZ. The provider is a Foster Care Agency is an agency that provides foster care as defined in the Code of Federal Regulations (CFR) as 24-hour substitute care for children outside their own homes. Foster care settings include, but are not limited to, nonrelative foster family homes, relative foster homes (whether payments are being made or not), group homes, emergency shelters, residential facilities, and pre-adoptive homes. Jerome Alexander-terrell Jackson NPI is 1740815497. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

9680 W NORTHERN AVE UNIT 2311
PEORIA, AZ
ZIP 85345-655
Phone: (989) 980-8286
Fax: (602) 455-4626

The enumeration date for this NPI number is 3/3/2020 and was last updated on 3/3/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	385HR2055X	Respite Care	Respite Care, Mental Illness, Child	10195508	ARIZONA	No
2	253J00000X	Foster Care Agency		10195508	ARIZONA	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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