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General NPI Number Information
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NPI Number | 1972840494
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Entity Type | Organization
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Legal Business Name | JB SIGNATURE HOMES, LLC
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Dates
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Enumeration Date | 01/04/2013
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Last Update Date | 01/04/2013
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Provider Practice Location Address
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Address Line | 1655 2ND AVE
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City | CUMBERLAND
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State | WI
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Zip | 54829-9229
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Country | US
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Telephone | 715-296-5415
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Fax |
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Provider Business Mailing Address
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Address Line | 2520 19 1/8 ST
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City | RICE LAKE
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State | WI
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Zip | 54868-9210
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JEFFREY BEYREIS
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Credential |
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Telephone | 715-296-5415
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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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