Provider Demographics
NPI:1962576769
Name:JJR ENTERPRISES INC
Entity type:Organization
Organization Name:JJR ENTERPRISES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:QUICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-244-7701
Mailing Address - Street 1:PO BOX 705
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-0015
Mailing Address - Country:US
Mailing Address - Phone:618-244-7701
Mailing Address - Fax:618-244-7704
Practice Address - Street 1:4241 LINCOLNSHIRE DR
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-2157
Practice Address - Country:US
Practice Address - Phone:618-242-0132
Practice Address - Fax:618-242-9180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0043810315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL14G198OtherPROVIDER IDENTIFICATION #
IL0043810OtherLG TERM CARE ICF DD 16
IL6011860OtherFACILITY ID