MEDICARE: JBC HOMES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility	AS610015096	MI

General Provider Information

NPI Number	:	1477791275
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JBC HOMES LLC

Provider Business Mailing Address
First Line	:	2508 MCILWRAITH ST
Second Line	:
City	:	MUSKEGON HTS
State	:	MI
Zip	:	49444-1633
Country	:	US
Telephone Number	:	231-737-0015
Fax Number	:	231-737-0015

Provider Business Practice Location Address
First Line	:	2508 MCILWRAITH ST
Second Line	:
City	:	MUSKEGON HTS
State	:	MI
Zip	:	49444-1633
Country	:	US
Telephone Number	:	231-737-0015
Fax Number	:	231-737-0015

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JOHN S THORNTON JR.
Credential	:	CARE PROVIDER
Telephone Number	:	231-737-0015

Provider Enumeration Date	:	02/02/2009
Last Update Date	:	02/02/2009

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