BEVERLY JACKSON

GARY, IN
NPI1871902247
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy320800000X Community Based Residential Treatment Facility, Mental Illness
Enumeration Date2014-08-10
Last Update Date2014-08-10
Business Address
-- BEVERLY JACKSON
1100 W 6TH AVE
GARY, IN 46402-1711
Phone number: 219-885-4264
Mailing Address
-- BEVERLY JACKSON
1100 W 6TH AVE
GARY, IN 46402-1711
Phone number: 219-885-4264
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