Provider Demographics
NPI:1316248040
Name:JWR ENTERPRISES, LLC
Entity type:Organization
Organization Name:JWR ENTERPRISES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:J
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-316-2569
Mailing Address - Street 1:2722 E MICHIGAN AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-4037
Mailing Address - Country:US
Mailing Address - Phone:517-316-2569
Mailing Address - Fax:517-316-3854
Practice Address - Street 1:2722 E MICHIGAN AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-4037
Practice Address - Country:US
Practice Address - Phone:517-316-2569
Practice Address - Fax:517-316-3854
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JWR ENTERPRISES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-11
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251E00000X
261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0009156Medicaid