# JACKSON STYLE ADULT DAY CARE

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** JACKSON STYLE LLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1871779280
- **Legal business name:** JACKSON STYLE LLC
- **Authorized official:** MR. CLEOTHA JACKSON (ADMINISTRATIVE ASSISTANT)
- **Authorized official phone:** (816) 769-8565

## Contact information

- **Practice address:** 12707 2ND ST, GRANDVIEW, MO 64030-2207
- **Practice address phone:** (816) 763-1078
- **Practice address fax:** (816) 765-9987
- **Mailing address:** 12707 2ND ST, GRANDVIEW, MO 64030-2207
- **Mailing address phone:** (816) 763-1078
- **Mailing address fax:** (816) 765-9987

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | 734 | MO | Yes |

## Other

- **Enumeration date:** 01/15/2008
- **Last updated:** 01/15/2008