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Jackson Group Home Llc
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Hannibal, Missouri
NPI 1588946370

Jackson Group Home Llc is a Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility based in Hannibal, MO. Jackson Group Home Llc practices in Hannibal, MO. The NPI Number for Jackson Group Home Llc is 1588946370 and holds a License No. 2500-12463 (Missouri).

The current practice location address for Jackson Group Home Llc is 18 Ridgewood Dr, Hannibal, MO and can be reached out via phone at 573-221-4671 and via fax at 573-221-4671.

Location: 18 Ridgewood Dr, Hannibal, MO, 63401-3056
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1588946370
Provider Name
Jackson Group Home Llc
Credential
Provider Entity Type
Organization
Address
18 Ridgewood Dr, Hannibal, MO, 63401-3056
Phone Number
573-221-4671
Fax Number
573-221-4671
Provider Enumeration Date
09/16/2011
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
18 Ridgewood Dr
City
Hannibal
State
Missouri
Zip
63401-3056
Phone Number
573-221-4671
Fax Number
573-221-4671
person
Provider Business Mailing Address Details
Address
18 Ridgewood Dr
City
Hannibal
State
Missouri
Zip
63401-3056
Phone Number
573-221-4671
Fax Number
573-221-4671
person
Provider's Taxonomy Details 1
Type
Residential Treatment Facilities
Classification
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Speciality
-
Taxonomy
320900000X
License No.
2500-12463 (Missouri)
Definition
A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with intellectual and/or developmental disabilities.
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