Healthcare Provider Details

I. General information

NPI: 1205663499
Provider Name (Legal Business Name): J A K ENTERPRISES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2024
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17A LITCHFIELD PLAZA
LITCHFIELD IL
62056-1050
US

IV. Provider business mailing address

8309 N KNOXVILLE AVE
PEORIA IL
61615-2170
US

V. Phone/Fax

Practice location:
  • Phone: 217-385-0922
  • Fax:
Mailing address:
  • Phone: 309-693-9540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DIANA J. HALL
Title or Position: OWNER
Credential:
Phone: 309-693-9540