Most Relevant Information
Provider Data
| NPI Number: | 1003513599 |
| Provider Name: | CHARLES DANGELO JACKSON |
| Entity Type: | Individual |
| Taxonomy Code: | 251E00000X |
| Specialty: | Home Health |
| License Number: |
Most Important Dates
| Enumeration Date: | 02/14/2023 |
| Last Updated: | 02/14/2023 |
Provider Practice Location
326 STUBBS DR
TROTWOOD
OH
454263109
Practice Location Phone/Fax
| Phone: | 5133285132 |
| Fax: |
Provider Mailing Location
326 STUBBS DR
TROTWOOD
OH
454263109
Provider Mailing Phone/Fax
| Phone: | 5133285132 |
| Fax: |