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General NPI Number Information
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NPI Number | 1790138956
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Entity Type | Organization
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Legal Business Name | SAMUEL AND JILL HIERONYMUS
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Dates
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Enumeration Date | 07/22/2016
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Last Update Date | 08/04/2016
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Provider Practice Location Address
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Address Line | 127 TOWER DR
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City | WARSAW
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State | MO
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Zip | 65355-3439
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Country | US
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Telephone | 660-335-0091
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Fax | 660-335-0092
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Provider Business Mailing Address
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Address Line | PO BOX 204
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City | SWEET SPRINGS
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State | MO
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Zip | 65351-0204
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Country | US
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Telephone | 660-335-0091
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Fax | 660-335-0092
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Authorized Official
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Title or Position | OWNER
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Name | MRS. JILL HIERONYMUS
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Credential |
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Telephone | 660-335-0091
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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 |
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License Number State |
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