Organization
PERSONAL TOUCH
Active
Parent organization
JACKSON GROUP HOME
Other names
JACKSON GROUP HOME
Organization subpart
Yes
Provider details
NPI number
Legal business name
JACKSON GROUP HOME
Authorized official
MRS. EARNESTINE JACKSON (ADMINISTRATOR)
(573) 688-2002
Entity
Organization
Contact information
Practice address
7570 US HIGHWAY 61, NEW MADRID, MO 63869-9183
(573) 688-2002
(573) 688-5174
Mailing address
PO BOX 176, LILBOURN, MO 63862-0176
(573) 688-2002
(573) 688-5174
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
MO
Other
Enumeration date
11/28/2007
Last updated
11/28/2007
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