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General NPI Number Information
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NPI Number | 1942746250
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Entity Type | Organization
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Legal Business Name | JRG 4, INC.
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Dates
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Enumeration Date | 01/10/2017
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Last Update Date | 01/10/2017
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Provider Practice Location Address
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Address Line | 3077 W JEFFERSON ST SUITE 218
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City | JOLIET
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State | IL
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Zip | 60435-5262
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Country | US
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Telephone | 815-725-2050
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Fax | 815-725-2110
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Provider Business Mailing Address
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Address Line | 1800 SUNSET LN
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City | MORRIS
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State | IL
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Zip | 60450-6814
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Country | US
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Telephone | 815-725-2050
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Fax | 815-725-2110
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Authorized Official
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Title or Position | OWNER
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Name | MR. ERIC PUCEL
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Credential |
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Telephone | 815-725-2050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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