Provider Demographics
NPI:1366892580
Name:JBL GROUP ENTERPRISE LIMITED
Entity type:Organization
Organization Name:JBL GROUP ENTERPRISE LIMITED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:GERTHA
Authorized Official - Middle Name:JUANITA
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-580-0053
Mailing Address - Street 1:1223 W 87TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60620-4042
Mailing Address - Country:US
Mailing Address - Phone:773-580-0053
Mailing Address - Fax:708-223-7898
Practice Address - Street 1:1223 W 87TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60620-4042
Practice Address - Country:US
Practice Address - Phone:773-580-0053
Practice Address - Fax:708-223-7898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-18
Last Update Date:2016-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)