Provider Demographics
NPI:1164257622
Name:FELIPITA C. JACKS
Entity type:Organization
Organization Name:FELIPITA C. JACKS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CHW SP. 2
Authorized Official - Prefix:MS
Authorized Official - First Name:FELIPITA
Authorized Official - Middle Name:C
Authorized Official - Last Name:JACKS
Authorized Official - Suffix:
Authorized Official - Credentials:CHW SPECIALIST 2
Authorized Official - Phone:505-319-9591
Mailing Address - Street 1:319 LOS PINOS RD
Mailing Address - Street 2:
Mailing Address - City:BERNALILLO
Mailing Address - State:NM
Mailing Address - Zip Code:87004-6505
Mailing Address - Country:US
Mailing Address - Phone:505-319-9591
Mailing Address - Fax:
Practice Address - Street 1:319 LOS PINOS RD
Practice Address - Street 2:
Practice Address - City:BERNALILLO
Practice Address - State:NM
Practice Address - Zip Code:87004-6505
Practice Address - Country:US
Practice Address - Phone:505-319-9591
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-04
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty