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General NPI Number Information
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NPI Number | 1740404896
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Entity Type | Organization
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Legal Business Name | J & J MAUPIN GROUP HOMES INC.
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5310 E WILLIAM STREET RD
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City | DECATUR
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State | IL
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Zip | 62521-1874
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Country | US
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Telephone | 217-422-6361
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Fax | 217-422-6365
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Provider Business Mailing Address
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Address Line | 5310 E WILLIAM STREET RD
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City | DECATUR
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State | IL
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Zip | 62521-1874
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Country | US
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Telephone | 217-422-6361
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Fax | 217-422-6365
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JEREMY RAY MAUPIN
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Credential |
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Telephone | 217-422-6361
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number | 0047290
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License Number State | IL
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