Joe Jac Corp.

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

License

0045955 Issued in IL

Legal business name

JOE JAC CORP.

Doing business as

Spring Creek Terrace

Practice address

5310 E William Street Rd
Decatur, IL 62521-1874

Phone

(217) 422-6361

Fax

(217) 422-6365

NPI assigned

Apr 10, 2007

Last updated

Jun 18, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Jeremy Ray Maupin

Title

President

Phone

(217) 422-6361

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Spring Creek Terrace Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213747200000",
    "number": "1285857284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5310 E WILLIAM STREET RD",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625211874",
            "telephone_number": "217-422-6361",
            "fax_number": "217-422-6365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5310 E WILLIAM STREET RD",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625211874",
            "telephone_number": "217-422-6361",
            "fax_number": "217-422-6365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOE JAC CORP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-10",
        "last_updated": "2008-06-18",
        "status": "A",
        "authorized_official_last_name": "MAUPIN",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_middle_name": "RAY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "217-422-6361",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "IL",
            "license": "0045955",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6012314",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Spring Creek Terrace",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Intellectual Disabilities Intermediate Care Facility in Decatur, IL
• Providers in Decatur, IL by specialty
• Intellectual Disabilities Intermediate Care Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.