WILLIE JACKSON
NPI 1144061649
Residential Treatment Facility, Intellectual and/or Developmental Disabilities in Mesa, AZ

Q: What is Willie Jackson's NPI number?

The NPI number for Willie Jackson is 1144061649. It was assigned to this individual provider in the NPPES registry on June 6, 2024.

Q: What is Willie Jackson's specialty?

The primary specialty registered for this NPI is Residential Treatment Facility, Intellectual and/or Developmental Disabilities with taxonomy code 320600000X.

Q: When was this NPI record last updated?

The NPPES record for Willie Jackson was last updated on January 30, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since June 06, 2024

400 N PIMA, MESA, AZ 85201(602) 551-0659 Get Directions Write a Review

NPPES record last updated: January 30, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jan 30, 2026, Jun 6, 2024 (2 updates tracked since 2024).

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About Willie Jackson NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

WILLIE JACKSON (NPI 1144061649) is an individual residential treatment facility, intellectual and/or developmental disabilities provider in Mesa, Arizona and active in the NPI registry since June 2024.

NPPES Registry Identity

NPI1144061649

Entity TypeIndividualMale

Primary Taxonomy320600000X

Provider Legal NameWILLIE JACKSON

Location Address400 N PIMAMesa, AZ 85201-5907

Mailing Address6410 S 58th AveLaveen, AZ 85339-2262 · (602) 551-0659

Phone(602) 551-0659

Sole ProprietorYes

Enumeration DateJune 6, 2024

Last NPPES UpdateJanuary 30, 20262 updates tracked since enumeration

NPPES CertifiedJanuary 30, 2026

✔ NPI 1144061649 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyResidential Treatment Facility, Intellectual and/or Developmental DisabilitiesResidential Treatment Facilities

Taxonomy Code320600000X

Definition

A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental and intellectual disabilities and are not able to live independently.

Also ListedBehavior TechnicianTaxonomy 106S00000X

Also ListedClinic/Center · RehabilitationTaxonomy 261QR0400X · License 23683875 (AZ)

400 N PIMA, Mesa, AZ 85201

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Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Willie Jackson's NPI number?

The NPI number for Willie Jackson is 1144061649. It was assigned to this individual provider in the NPPES registry on June 6, 2024.

Where is Willie Jackson located?

Willie Jackson practices at 400 N Pima, Mesa, AZ 85201. The listed phone number is (602) 551-0659.

What is Willie Jackson's specialty?

The primary specialty registered for this NPI is Residential Treatment Facility, Intellectual and/or Developmental Disabilities with taxonomy code 320600000X.

When was this NPI record last updated?

The NPPES record for Willie Jackson was last updated on January 30, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.