JACKSON VA FACILITY DOM (3672) INSTITUTION (4)

Name	Value
NAME	JACKSON VA FACILITY DOM
STATE	MISSISSIPPI
STREET ADDR. 1	1500 E WOODROW WILSON AVE
CITY	JACKSON
ZIP	39216-5116
OFFICIAL VA NAME	JACKSON VA FACILITY DOMICILIARY
STATUS	National
ASSOCIATIONS	VISN PARENT OF ASSOCIATION: VISN 16 PARENT FACILITY PARENT OF ASSOCIATION: JACKSON VAMC
BILLING FACILITY NAME	JACKSON VA CARE SITE
EFFECTIVE DATE/TIME	2015-09-01 00:00:00 STATUS: ACTIVE NPI: 1154784965
TAXONOMY CODE	Residential Treatment Facilities PRIMARY CODE: YES STATUS: ACTIVE
LOCATION TIMEZONE	CENTRAL
COUNTRY	USA
STATION NUMBER	586BU