Organization
JACKIE R WHITE
Active
Other names
White Family ISL
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JACKIE R WHITE (ADMINISTRATOR)
(660) 673-6139
Entity
Organization
Contact information
Practice address
730 NE 25TH ST, GALT, MO 64641-9153
(660) 673-6139
Mailing address
730 NE 25TH ST, GALT, MO 64641-9153
(660) 673-6139
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Enumeration date
06/21/2007
Last updated
07/22/2008
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