MEDICARE: JJR ENTERPRISES INC

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	315P00000X	Intellectual Disabilities Intermediate Care Facility	0043810	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14G198	OTHER	IL	PROVIDER IDENTIFICATION #
2	0043810	OTHER	IL	LG TERM CARE ICF DD 16
3	6011860	OTHER	IL	FACILITY ID

General Provider Information

NPI Number	:	1962576769
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JJR ENTERPRISES INC

Provider Business Mailing Address
First Line	:	PO BOX 705
Second Line	:
City	:	MOUNT VERNON
State	:	IL
Zip	:	62864-0015
Country	:	US
Telephone Number	:	618-244-7701
Fax Number	:	618-244-7704

Provider Business Practice Location Address
First Line	:	4241 LINCOLNSHIRE DR
Second Line	:
City	:	MOUNT VERNON
State	:	IL
Zip	:	62864-2157
Country	:	US
Telephone Number	:	618-242-0132
Fax Number	:	618-242-9180

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	BETH A QUICK
Credential	:
Telephone Number	:	618-244-7701

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	08/22/2020

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