Organization
HOLISTIC INDIVIDUAL SUPPORT LIVING LLC
Active
Other names
Holistic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOVIN M BAYINGANA DNP, DR. (CEO)
(207) 518-7073
Entity
Organization
Contact information
Practice address
529 AURORA AVE, JEFFERSON CITY, MO 65101-2816
(202) 518-7073
Mailing address
529 AURORA AVE, JEFFERSON CITY, MO 65101-2816
(207) 518-7073
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
12/14/2024
Last updated
12/30/2024
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