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Organization
JOE JAC CORP.
Active
Organization
JOE JAC CORP.
Active
Other names
Spring Creek Terrace
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEREMY RAY MAUPIN (PRESIDENT)
(217) 422-6361
Entity
Organization
Contact information
Practice address
5310 E WILLIAM STREET RD, DECATUR, IL 62521-1874
(217) 422-6361
(217) 422-6365
Mailing address
5310 E WILLIAM STREET RD, DECATUR, IL 62521-1874
(217) 422-6361
(217) 422-6365
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
0045955
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6012314
—
IL
Enumeration date
04/10/2007
Last updated
06/18/2008
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