Organization
RELIANT CARE REHABILITATIVE SERVICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DARRYL RAYNOR JACKSON JR. (COTA/L)
(573) 629-0321
Entity
Organization
Contact information
Practice address
1734 MARKET ST, HANNIBAL, MO 63401-4025
(573) 629-0321
Mailing address
1734 MARKET ST, HANNIBAL, MO 63401-4025
Taxonomy
Speciality
Code
Description
License number
State
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
Primary
201000472
MO
Other
Enumeration date
06/08/2012
Last updated
06/08/2012
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