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General NPI Number Information
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NPI Number | 1467106757
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Entity Type | Organization
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Legal Business Name | A PLACE TO BELONG ISL LLC
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Dates
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Enumeration Date | 02/07/2022
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Last Update Date | 02/07/2022
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Provider Practice Location Address
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Address Line | 303 N STADIUM BLVD STE 200
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City | COLUMBIA
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State | MO
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Zip | 65203-1429
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Country | US
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Telephone | 573-530-0523
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Fax | 573-507-6033
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Provider Business Mailing Address
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Address Line | PO BOX 7021
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City | COLUMBIA
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State | MO
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Zip | 65205-7021
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Country | US
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Telephone | 573-530-0523
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Fax | 573-507-6033
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Authorized Official
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Title or Position | OWNER
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Name | MRS. TRELLENE LLOYD
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Credential |
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Telephone | 573-530-0523
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number |
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License Number State |
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