1. Home
  2. Directory
  3. Indiana
  4. Gary
  5. Community Based Residential Treatment Facility Mental Illness
  6. NPI Profile

BEVERLY JACKSON
NPI 1871902247
Community Based Residential Treatment Facility, Mental Illness in Gary, IN

Active since August 10, 2014
1100 W 6TH AVE, GARY, IN 46402(219) 885-4264 Get Directions Write a Review

NPPES record last updated: August 10, 2014. Verified against the NPPES registry weekly; last sync: August 23, 2026.

About Beverly Jackson NPPES

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

BEVERLY JACKSON (NPI 1871902247) is an individual community based residential treatment facility, mental illness provider in Gary, Indiana and active in the NPI registry since August 2014.

NPPES Registry Identity

NPI1871902247
Entity TypeIndividualFemale
Primary Taxonomy320800000X
Provider Legal NameBEVERLY JACKSON
Location Address1100 W 6TH AVEGary, IN 46402-1711
Mailing Address1100 W 6th AveGary, IN 46402-1711 · (219) 885-4264
Phone(219) 885-4264
Sole ProprietorYes
Enumeration DateAugust 10, 2014
✔ NPI 1871902247 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCommunity Based Residential Treatment Facility, Mental IllnessResidential Treatment Facilities
Taxonomy Code320800000X
Definition
A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness.
1100 W 6TH AVE, Gary, IN 46402
Open in Google Maps ↗

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. LARESSE HARRIS APRN, FNP-C
Nurse Practitioner (Family)
1100 W 6TH AVE
GARY, IN 46402
Lake County (219) 885-4264
DAWN RANDLE
Behavior Technician
1100 W 6TH AVE
GARY, IN 46402
Lake County (219) 885-4264
RESEDA STURDIVANT
Technician, Other
1100 W 6TH AVE
GARY, IN 46402
Lake County (219) 885-4264
LYTINA NICOLE BARNETT
Social Worker
1100 W 6TH AVE
GARY, IN 46402
Lake County (219) 885-4264
JEWEL YVETTA JONES
Technician (Attendant Care Provider)
1100 W 6TH AVE
GARY, IN 46402
Lake County (219) 885-4264
DIANEA' LYNN MCINTOSH
Behavior Analyst
1100 W 6TH AVE
GARY, IN 46402
Lake County (219) 885-4264
MARSHA CLARK RN
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
1100 W 6TH AVE
GARY, IN 46402
Lake County (219) 240-8615
SHANELL LITHRESE HIGHTOWER
Counselor
1100 W 6TH AVE
GARY, IN 46402
Lake County (219) 885-4264

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 Beverly Jackson's NPI number?

The NPI number for Beverly Jackson is 1871902247. It was assigned to this individual provider in the NPPES registry on August 10, 2014.

Where is Beverly Jackson located?

Beverly Jackson practices at 1100 W 6th Ave, Gary, IN 46402. The listed phone number is (219) 885-4264.

What is Beverly Jackson's specialty?

The primary specialty registered for this NPI is Community Based Residential Treatment Facility, Mental Illness with taxonomy code 320800000X.

When was this NPI record last updated?

The NPPES record for Beverly Jackson was last updated on August 10, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 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.