Provider Demographics
NPI:1629748074
Name:JAMREN NURSING CARE SERVICE LLC
Entity Type:Organization
Organization Name:JAMREN NURSING CARE SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MATHIEW
Authorized Official - Middle Name:
Authorized Official - Last Name:NGATI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-364-0012
Mailing Address - Street 1:507 WHIPPOORWILL LN
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-5539
Mailing Address - Country:US
Mailing Address - Phone:301-605-2799
Mailing Address - Fax:
Practice Address - Street 1:507 WHIPPOORWILL LN
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-5539
Practice Address - Country:US
Practice Address - Phone:301-605-2799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-16
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL400642Medicaid