Provider Demographics
NPI:1013481571
Name:JBL GROUP
Entity Type:Organization
Organization Name:JBL GROUP
Other - Org Name:EVOLVE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EUNICE
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-489-4715
Mailing Address - Street 1:2 W 103RD ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-2619
Mailing Address - Country:US
Mailing Address - Phone:312-489-4715
Mailing Address - Fax:
Practice Address - Street 1:200 E 75TH ST STE 600
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-2284
Practice Address - Country:US
Practice Address - Phone:312-858-2550
Practice Address - Fax:312-878-2291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-17
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center