Provider Demographics
NPI:1942746250
Name:JRG 4, INC.
Entity Type:Organization
Organization Name:JRG 4, INC.
Other - Org Name:HOME INSTEAD SENIOR CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:PUCEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-725-2050
Mailing Address - Street 1:1800 SUNSET LN
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-6814
Mailing Address - Country:US
Mailing Address - Phone:815-725-2050
Mailing Address - Fax:815-725-2110
Practice Address - Street 1:3077 W JEFFERSON ST
Practice Address - Street 2:SUITE 218
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-5262
Practice Address - Country:US
Practice Address - Phone:815-725-2050
Practice Address - Fax:815-725-2110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health