Organization
INTEGRATED LIFESTYLES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JON GILLIOM (ADMINISTRATOR)
(573) 445-4409
Entity
Organization
Contact information
Practice address
820 BOURN AVE, COLUMBIA, MO 65203-1459
(573) 445-4409
(573) 445-4409
Mailing address
820 BOURN AVE, COLUMBIA, MO 65203-1459
(573) 445-4409
(573) 445-4409
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
MO
Other
Enumeration date
10/16/2009
Last updated
10/16/2009
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