Provider Demographics
NPI:1477977684
Name:JAC ENTERPRISES, INC.
Entity Type:Organization
Organization Name:JAC ENTERPRISES, INC.
Other - Org Name:CHARIS PLACE ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNULTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-335-2050
Mailing Address - Street 1:701 NORTH FOREST DR
Mailing Address - Street 2:
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611
Mailing Address - Country:US
Mailing Address - Phone:907-335-2050
Mailing Address - Fax:907-335-2051
Practice Address - Street 1:701 NORTH FOREST DR
Practice Address - Street 2:
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611
Practice Address - Country:US
Practice Address - Phone:907-335-2050
Practice Address - Fax:907-335-2051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-07
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101027310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility