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General NPI Number Information
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NPI Number | 1427409812
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Entity Type | Organization
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Legal Business Name | JR'S CENTRE
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Dates
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Enumeration Date | 06/27/2016
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Last Update Date | 06/27/2016
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Provider Practice Location Address
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Address Line | 100 FLORSHEIM DR
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City | ANNA
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State | IL
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Zip | 62906-1906
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Country | US
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Telephone | 618-833-4956
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Fax | 618-833-5009
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Provider Business Mailing Address
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Address Line | 100 FLORSHEIM DR
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City | ANNA
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State | IL
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Zip | 62906-1906
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Country | US
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Telephone | 618-833-4956
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Fax | 618-833-5009
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | KATHERINE DIANE MCNEILL
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Credential | B.S.
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Telephone | 618-833-4956
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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