Individual ProviderRevis JacksonCase Manager/Care CoordinatorOther Service ProvidersPractice Address1102 Commercial Drive, Hammond, Louisiana 70403(985) 662-3799PECOS EnrollmentBased on the most recent information from CMS, provider Revis Jackson does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 8 days ago.Profile DetailsProvider ID1356936504Provider TypeIndividualFull NameJackson, RevisGenderMaleSole ProprietorNoEnumeration Date3/9/2021Last Updated3/9/2021Contact InformationPractice LocationPractice Address1102 Commercial Drive, Hammond, Louisiana 70403Phone(985) 662-3799FaxUnlisted FaxMailing LocationMailing Address1102 Commercial Dr, Hammond, LA 70403-5954PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode171M00000XPrimaryDescriptionCase Manager/Care CoordinatorOther Service ProvidersLicenseUnlisted Issuer