Basic Information
| Provider Information | |||||||||
| NPI: | 1508504309 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JACKSON RECOVERY CENTERS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 5TH ST STE 200 | ||||||||
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| City: | SIOUX CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 511011324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122342300 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2322 E KIMBERLY RD STE 200N | ||||||||
| Address2: | |||||||||
| City: | DAVENPORT | ||||||||
| State: | IA | ||||||||
| PostalCode: | 528077216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5633550055 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2022 | ||||||||
| LastUpdateDate: | 05/23/2022 | ||||||||
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| AuthorizedOfficialLastName: | GOMEL | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 8153911000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 05/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0405X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |
No ID Information.