Healthcare Provider Details

I. General information

NPI: 1861274979
Provider Name (Legal Business Name): JACOBUS FAMILY ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2023
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12136 S WILLIAMS CT
CROWN POINT IN
46307-8583
US

IV. Provider business mailing address

728 HARVEST LN
WASHINGTON TOWNSHIP OH
45458-4359
US

V. Phone/Fax

Practice location:
  • Phone: 219-765-3216
  • Fax:
Mailing address:
  • Phone: 219-765-3216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: BRENT JACOBUS II
Title or Position: MEMBER
Credential: MD
Phone: 219-765-3216