Provider Demographics
NPI:1942686456
Name:JACBRE INC.
Entity Type:Organization
Organization Name:JACBRE INC.
Other - Org Name:COMFORT KEEPERS 738
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:PAWLACZYK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-676-6643
Mailing Address - Street 1:3133 VAN HORN RD
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48183-4070
Mailing Address - Country:US
Mailing Address - Phone:738-676-6643
Mailing Address - Fax:734-676-6653
Practice Address - Street 1:3133 VAN HORN RD
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:MI
Practice Address - Zip Code:48183-4070
Practice Address - Country:US
Practice Address - Phone:738-676-6643
Practice Address - Fax:734-676-6653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-06
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health