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Organization

HOME CARE ISL, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
SUSAN STOTZ RN, QDDP (DIRECTOR)
(573) 631-1456
Entity
Organization

Contact information

Practice address
1018 JOHNSON STREET, FREDERICKTOWN, MO 63645-0467
(573) 631-1456
Mailing address
PO BOX 467, 1018 JOHNSON STREET, FREDERICKTOWN, MO 63645-0467

Taxonomy

Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
MO

Other

Enumeration date
11/30/2011
Last updated
11/30/2011
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