Organization
JJR ENTERPRISES INC
Active
Other names
TRAFFORD ESTATES
Organization subpart
No
Provider details
NPI number
Authorized official
BETH A QUICK (VICE PRESIDENT)
(618) 244-7701
Entity
Organization
Contact information
Practice address
813 W CENTER ST, FAIRFIELD, IL 62837-1403
(618) 842-2260
(618) 842-4228
Mailing address
PO BOX 705, MOUNT VERNON, IL 62864-0015
(618) 244-7701
(618) 244-7704
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
00143828
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0043828
LG TERM CARE ICF DD 16
IL
01
—
14G276
PROVIDER IDENTIFICATION #
IL
01
—
6012983
FACILITY ID
IL
Enumeration date
11/16/2006
Last updated
08/22/2020
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