Healthcare Provider Details

I. General information

NPI: 1437338282
Provider Name (Legal Business Name): TOMLONSON GROUP CARE HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2007
Last Update Date: 07/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 DUNDEE AVE
SEDALIA MO
65301-2337
US

IV. Provider business mailing address

2872 SOUTHGATE LOOP
SEDALIA MO
65301-8842
US

V. Phone/Fax

Practice location:
  • Phone: 660-851-0400
  • Fax:
Mailing address:
  • Phone: 660-827-1419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. HEATHER TOMLONSON
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 660-827-1419