Individual ProviderChaislen Destine JacksonCase Manager/Care CoordinatorOther Service ProvidersPractice Address115 S Reynolds Rd Ste C, Toledo, OH 43615-69581972566314PECOS EnrollmentBased on the most recent information from CMS, provider Chaislen Destine 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 7 days ago.Profile DetailsProvider ID1578206553Provider TypeIndividualFull NameJackson, Chaislen DestineGenderFemaleSole ProprietorYesEnumeration Date4/18/2022Last Updated3/10/2025Contact InformationPractice LocationPractice Address115 S Reynolds Rd Ste C, Toledo, OH 43615-6958Phone1972566314Fax(419) 725-6635Mailing LocationMailing Address865 Geneva Ave, Toledo, OH 43609-3037PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode171M00000XPrimaryDescriptionCase Manager/Care CoordinatorOther Service ProvidersLicenseUnlisted Issuer