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General NPI Number Information
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NPI Number | 1972637346
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Entity Type | Organization
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Legal Business Name | DILLAHUNT ISL
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 11/22/2010
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Provider Practice Location Address
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Address Line | 4300 ROYAL ABERDEEN ST
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City | COLUMBIA
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State | MO
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Zip | 65203-4810
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Country | US
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Telephone | 573-445-4408
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Fax | 573-445-4396
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Provider Business Mailing Address
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Address Line | 4300 ROYAL ABERDEEN ST
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City | COLUMBIA
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State | MO
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Zip | 65203-4810
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Country | US
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Telephone | 573-445-4408
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Fax | 573-445-4396
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Authorized Official
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Title or Position | OWNER
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Name | MS. NANCY JANE DILLAHUNT
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Credential | RN
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Telephone | 573-445-4408
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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 | 8001281
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License Number State | MO
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