Organization
JENE'S LTD BOUTIQUE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EUVIVA JENE ALCARAZ (PRESIDENT (OWNER))
(309) 694-7720
Entity
Organization
Contact information
Practice address
4700 N. UNIVERSITY, SPC 93 METRO CENTER, PEORIA, IL 61614-5849
(309) 694-7720
(309) 694-7748
Mailing address
P.O. BOX 2545, 312 ILLINI DRIVE, EAST PEORIA, IL 61611
(309) 694-7720
(309) 694-7748
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
C36319
IL
332B00000X
Durable Medical Equipment & Medical Supplies
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Other
Enumeration date
01/09/2007
Last updated
09/09/2009
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