Healthcare Provider Details

I. General information

NPI: 1326110594
Provider Name (Legal Business Name): JJR ENTERPRISES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 BROADWAY ST STE B
MOUNT VERNON IL
62864-2935
US

IV. Provider business mailing address

PO BOX 705
MOUNT VERNON IL
62864-0015
US

V. Phone/Fax

Practice location:
  • Phone: 618-244-7701
  • Fax: 618-244-7704
Mailing address:
  • Phone: 618-244-7701
  • Fax: 618-244-7704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number96S007
License Number StateIL

VIII. Authorized Official

Name: BETH ANN QUICK
Title or Position: VICE PRESIDENT
Credential:
Phone: 618-244-7701