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General NPI Number Information
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NPI Number | 1184754046
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Entity Type | Organization
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Legal Business Name | MAURIZI ISL HOME
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 04/09/2008
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Provider Practice Location Address
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Address Line | 2015 WOODHOLLOW DR
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City | COLUMBIA
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State | MO
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Zip | 65203-0909
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Country | US
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Telephone | 573-256-1296
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Fax | 573-256-1016
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Provider Business Mailing Address
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Address Line | 2015 WOODHOLLOW DR
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City | COLUMBIA
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State | MO
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Zip | 65203-0909
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Country | US
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Telephone | 573-256-1296
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Fax | 573-256-1016
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Authorized Official
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Title or Position | OWNER
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Name | MRS. TINA D MAURIZI
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Credential |
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Telephone | 573-256-1296
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 856917109
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License Number State | MO
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