IndividualActive
Demarcus Jackson
NPI 1912888405 · Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Memphis, TN
Provider details
- NPI number
- 1912888405
- Entity type
- Individual
- Primary specialty
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityResidential Treatment Facilities
- Sex
- Male
- Sole proprietor
- Yes
Specialties & taxonomies
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityPrimary320900000X
Residential Treatment Facilities
Practice location
938 Breedlove St
Memphis, TN 38107-4272
Phone: (901) 463-6940
Approximate (ZIP-level) locationGet directions
Mailing address
938 Breedlove St
Memphis, TN 38107-4272
Registry dates
- Enumerated
- 2025-09-10
- Last updated
- 2025-09-10
- Certified
- 2025-09-10
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.