Provider Demographics
NPI:1184255143
Name:JC ROBINSON ENTERPRISE, LLC
Entity type:Organization
Organization Name:JC ROBINSON ENTERPRISE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JERRELL
Authorized Official - Middle Name:DEMETRI
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-459-2763
Mailing Address - Street 1:41 SAINT ANTHONY LN
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-6720
Mailing Address - Country:US
Mailing Address - Phone:314-459-2763
Mailing Address - Fax:314-695-5271
Practice Address - Street 1:41 SAINT ANTHONY LN
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-6720
Practice Address - Country:US
Practice Address - Phone:314-459-2763
Practice Address - Fax:314-695-5271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health