Most Relevant Information
Provider Data
| NPI Number: | 1003204678 |
| Provider Name: | VANESSA JACKSON |
| Entity Type: | Individual |
| Taxonomy Code: | 311ZA0620X |
| Specialty: | Custodial Care Facility |
| License Number: | 320584 |
Most Important Dates
| Enumeration Date: | 01/05/2015 |
| Last Updated: | 01/05/2015 |
Provider Practice Location
2922 FALCON AVE
FAR ROCKAWAY
NY
116911845
Practice Location Phone/Fax
| Phone: | 3475769654 |
| Fax: |
Provider Mailing Location
2922 FALCON AVE
FAR ROCKAWAY
NY
116911845
Provider Mailing Phone/Fax
| Phone: | 3475769654 |
| Fax: |