Provider Demographics
NPI:1619383536
Name:JGL ENTERPRISES, INC.
Entity Type:Organization
Organization Name:JGL ENTERPRISES, INC.
Other - Org Name:REGENCY HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:CEBS
Authorized Official - Phone:503-616-0460
Mailing Address - Street 1:19965 SW 58TH TER
Mailing Address - Street 2:
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-6844
Mailing Address - Country:US
Mailing Address - Phone:503-616-0460
Mailing Address - Fax:
Practice Address - Street 1:15115 SW SEQUOIA PKWY STE 170
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97224-7156
Practice Address - Country:US
Practice Address - Phone:503-616-0460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-11
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR152232253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR137165Medicaid