Organization
JACKSON GROUP HOME LLC
Active
Organization
JACKSON GROUP HOME LLC
Active
Other names
Jackson Group Home
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LORA L CULP BSN, RN (OWNER/OPERATOR)
(573) 221-4671
Entity
Organization
Contact information
Practice address
18 RIDGEWOOD DR, HANNIBAL, MO 63401-3056
(573) 221-4671
(573) 221-4671
Mailing address
18 RIDGEWOOD DR, HANNIBAL, MO 63401-3056
(573) 221-4671
(573) 221-4671
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
2500-12463
MO
Other
Enumeration date
09/16/2011
Last updated
04/09/2017
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