Provider Demographics
NPI:1285214726
Name:JAC GROUP LLC
Entity Type:Organization
Organization Name:JAC GROUP LLC
Other - Org Name:A PLACE AT HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:C.W.
Authorized Official - Middle Name:
Authorized Official - Last Name:HURST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-433-4804
Mailing Address - Street 1:8310 S VALLEY HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-5815
Mailing Address - Country:US
Mailing Address - Phone:720-726-3789
Mailing Address - Fax:720-246-2920
Practice Address - Street 1:8310 S VALLEY HWY STE 300
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112-5815
Practice Address - Country:US
Practice Address - Phone:720-726-3799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-09
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care