Healthcare Provider Details

I. General information

NPI: 1962172304
Provider Name (Legal Business Name): INDIVIDUALIZED SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2021
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 IDLEWOOD RD
JEFFERSON CITY MO
65109-2119
US

IV. Provider business mailing address

2301 IDLEWOOD RD
JEFFERSON CITY MO
65109-2119
US

V. Phone/Fax

Practice location:
  • Phone: 573-418-1677
  • Fax:
Mailing address:
  • Phone: 573-418-1677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RITA DENOME
Title or Position: OWNER PROVIDER
Credential:
Phone: 573-418-1677