Healthcare Provider Details

I. General information

NPI: 1114269081
Provider Name (Legal Business Name): JOB CONNECTION SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2013
Last Update Date: 04/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 S OSTEOPATHY AVE
KIRKSVILLE MO
63501-1579
US

IV. Provider business mailing address

1001 S OSTEOPATHY AVE
KIRKSVILLE MO
63501-1579
US

V. Phone/Fax

Practice location:
  • Phone: 660-665-5768
  • Fax:
Mailing address:
  • Phone: 660-665-5768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. KATY FINE-NEWMAN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 660-665-5768