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General NPI Number Information
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NPI Number | 1295092500
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Entity Type | Organization
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Legal Business Name | JAK PROPERTIES INC
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Dates
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Enumeration Date | 04/12/2012
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Last Update Date | 12/23/2022
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Provider Practice Location Address
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Address Line | 400 M C BLACK RD
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City | BONNE TERRE
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State | MO
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Zip | 63628-3649
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Country | US
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Telephone | 573-358-7755
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Fax | 573-358-7788
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Provider Business Mailing Address
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Address Line | 400 M C BLACK RD
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City | BONNE TERRE
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State | MO
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Zip | 63628-3649
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Country | US
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Telephone | 573-358-7755
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Fax | 573-358-7788
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | AMY SUE PROFFER
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Credential |
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Telephone | 573-358-7755
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 372500000X
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Taxonomy Name | Chore Provider
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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