National Provider Identifier Database

JACQUENETT JACKSON
Adult Care Home

A custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment.


Contact Information

JACQUENETT JACKSON
114 SECOND STREET
SHUBUTA, MS39360
Phone: 601-687-1128
Fax: 601-687-5497
Website:
Specialty Taxonomy Code
* Adult Care Home 311ZA0620X

* Indicates primary specialty

NPI Profile & details for JACQUENETT JACKSON

NPI Number 1376727388
Credentials
Entity Individual
Enumeration date 12/27/2007
Last updated 12/27/2007 - About 18 years ago
Sole proprietor1 Yes
Identifiers
  • MS Medicaid: 00770581
Hospital affiliation n/a

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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