Provider Demographics
NPI:1295092500
Name:JAK PROPERTIES INC
Entity type:Organization
Organization Name:JAK PROPERTIES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:PROFFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-358-7755
Mailing Address - Street 1:400 M C BLACK RD
Mailing Address - Street 2:
Mailing Address - City:BONNE TERRE
Mailing Address - State:MO
Mailing Address - Zip Code:63628-3649
Mailing Address - Country:US
Mailing Address - Phone:573-358-7755
Mailing Address - Fax:573-358-7788
Practice Address - Street 1:400 M C BLACK RD
Practice Address - Street 2:
Practice Address - City:BONNE TERRE
Practice Address - State:MO
Practice Address - Zip Code:63628-3649
Practice Address - Country:US
Practice Address - Phone:573-358-7755
Practice Address - Fax:573-358-7788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-12
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day CareGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive Care
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No372500000XNursing Service Related ProvidersChore ProviderGroup - Multi-Specialty