Provider Demographics
NPI:1356373153
Name:JACKSON HOME MEDICAL EQUIPMENT, INC.
Entity type:Organization
Organization Name:JACKSON HOME MEDICAL EQUIPMENT, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:L
Authorized Official - Last Name:MODRESKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-787-6910
Mailing Address - Street 1:807 S BROWN ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-1430
Mailing Address - Country:US
Mailing Address - Phone:517-787-6910
Mailing Address - Fax:517-782-8502
Practice Address - Street 1:807 S BROWN ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-1430
Practice Address - Country:US
Practice Address - Phone:517-787-6910
Practice Address - Fax:517-782-8502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI119550OtherGREAT LAKES HEALTH PLAN #
MI303472887Medicaid
MI540C81221OtherBCBS PROVIDER ID NUMBER
MI119550OtherGREAT LAKES HEALTH
MI1208OtherNORTHWOOD PROVIDER ID NUM
MI3034728Medicaid
MI52543OtherNORTHWOOD NPN PROVIDER ID
MI303472887Medicaid