Individual ProviderLatoria Ware-JacksonCase Manager/Care CoordinatorOther Service ProvidersPractice Address514 Chickasawba St, Blytheville, AR 72315-2722(870) 824-2268(866) 972-1268PECOS EnrollmentBased on the most recent information from CMS, provider Latoria Ware-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 3 days ago.Profile DetailsProvider ID1427390335Provider TypeIndividualFull NameWare-Jackson, LatoriaGenderFemaleSole ProprietorNoEnumeration Date3/19/2013Last Updated8/20/2020Contact InformationPractice LocationPractice Address514 Chickasawba St, Blytheville, AR 72315-2722Phone(870) 824-2268Fax(870) 824-2268Mailing LocationMailing Address2809 Forest Home Rd, Jonesboro, AR 72401-5320Phone(866) 972-1268FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode171M00000XPrimaryDescriptionCase Manager/Care CoordinatorOther Service ProvidersLicenseUnlisted Issuer