| NPI | 1295550176 |
|---|---|
| Doing Business As | JACKIE'S PLACE |
| Entity Type | Organization |
| Authorized Contact | DEBORAH JOHNSON Executive Director 251-605-9372 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2024-11-18 |
| Last Update Date | 2024-11-18 |