1. Home
  2. Directory
  3. North Carolina
  4. Fairmont
  5. Residential Treatment Facility Emotionally Disturbed Children
  6. NPI Profile

JACKSON HOME, INC.
NPI 1285838805
Residential Treatment Facility, Emotionally Disturbed Children in Fairmont, NC

Active since June 14, 2007
509 HOLLY ST, FAIRMONT, NC 28340(910) 628-7171 Get Directions Write a Review

NPPES record last updated: August 22, 2020. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Jackson Home, Inc. NPPES

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

JACKSON HOME, INC. (NPI 1285838805) is a healthcare organization registered as a residential treatment facility, emotionally disturbed children in Fairmont, North Carolina and active in the NPI registry since June 2007. The organization lists Glenda T Jackson, Director, as its authorized official.

NPPES Registry Identity

NPI1285838805
Entity TypeOrganization
Primary Taxonomy322D00000X
Legal Business NameJACKSON HOME, INC.
Location Address509 HOLLY STFairmont, NC 28340-1705
Mailing Address509 Holly StFairmont, NC 28340-1705
Phone(910) 628-7171
Organization SubpartNo
Authorized OfficialGlenda T JacksonDirector · (910) 628-7171
Enumeration DateJune 14, 2007
Last NPPES UpdateAugust 22, 2020
✔ NPI 1285838805 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyResidential Treatment Facility, Emotionally Disturbed ChildrenResidential Treatment Facilities
Taxonomy Code322D00000X
License✔ Licensed in NC · MHL078158
Definition
A residential facility that provides habilitation services and other care and treatment to children diagnosed with mental health illness, behavioral issues, and intellectual disabilities and are not able to live independently.
509 HOLLY ST, Fairmont, NC 28340
Open in Google Maps ↗

Other Identifiers 1

Medicaid6603889NC

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 Jackson Home, Inc.'s NPI number?

The NPI number for Jackson Home, Inc. is 1285838805. It was assigned to this organization in the NPPES registry on June 14, 2007.

Where is Jackson Home, Inc. located?

Jackson Home, Inc. is located at 509 Holly St, Fairmont, NC 28340. The listed phone number is (910) 628-7171.

What is Jackson Home, Inc.'s specialty?

The primary specialty registered for this NPI is Residential Treatment Facility, Emotionally Disturbed Children with taxonomy code 322D00000X.

When was this NPI record last updated?

The NPPES record for Jackson Home, Inc. was last updated on August 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years 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.