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General NPI Number Information
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NPI Number | 1336264647
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Entity Type | Organization
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Legal Business Name | JUSTUS
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5514 E YOSEMITE AVE
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City | COLUMBIA
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State | MO
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Zip | 65201-6830
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Country | US
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Telephone | 573-489-2206
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Fax | 573-474-8496
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Provider Business Mailing Address
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Address Line | 5514 E YOSEMITE AVE
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City | COLUMBIA
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State | MO
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Zip | 65201-6830
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Country | US
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Telephone | 573-489-2206
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Fax | 573-474-8496
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Authorized Official
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Title or Position | OWNER
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Name | TAMARA SUE WILLIAMS
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Credential |
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Telephone | 573-489-2206
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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