Healthcare Provider Details

I. General information

NPI: 1316248040
Provider Name (Legal Business Name): JWR ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2010
Last Update Date: 04/04/2023
Certification Date: 04/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2722 E MICHIGAN AVE SUITE 100
LANSING MI
48912-4037
US

IV. Provider business mailing address

2722 E MICHIGAN AVE SUITE 100
LANSING MI
48912-4037
US

V. Phone/Fax

Practice location:
  • Phone: 517-316-2569
  • Fax: 517-316-3854
Mailing address:
  • Phone: 517-316-2569
  • Fax: 517-316-3854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateMI

VIII. Authorized Official

Name: MRS. DEBRA J RILEY
Title or Position: CO-OWNER
Credential:
Phone: 517-316-2569