Provider Demographics
NPI:1427501998
Name:JT CARE LLC
Entity type:Organization
Organization Name:JT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:IT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:NICKLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-501-0996
Mailing Address - Street 1:1S443 SUMMIT AVE
Mailing Address - Street 2:204 A&B
Mailing Address - City:OAKBROOK TERRACE
Mailing Address - State:IL
Mailing Address - Zip Code:60181-3989
Mailing Address - Country:US
Mailing Address - Phone:630-501-0996
Mailing Address - Fax:
Practice Address - Street 1:1S443 SUMMIT AVE
Practice Address - Street 2:204 A&B
Practice Address - City:OAKBROOK TERRACE
Practice Address - State:IL
Practice Address - Zip Code:60181-3989
Practice Address - Country:US
Practice Address - Phone:630-501-0996
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-01
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILIL6004964313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL452820443003Medicaid