1790138956 NPI number — SAMUEL AND JILL HIERONYMUS

Table of content: (NPI 1790138956)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790138956 NPI number — SAMUEL AND JILL HIERONYMUS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAMUEL AND JILL HIERONYMUS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
TWIN OAKS INDEPENDENT LIVING II
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790138956
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/04/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 204
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SWEET SPRINGS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65351-0204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
660-335-0091
Provider Business Mailing Address Fax Number:
660-335-0092

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
127 TOWER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARSAW
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65355-3439
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
660-335-0091
Provider Business Practice Location Address Fax Number:
660-335-0092
Provider Enumeration Date:
07/22/2016

Additional Information

Authorized Official

Authorized Official Last Name:
HIERONYMUS
Authorized Official First Name:
JILL
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
660-335-0091

Provider Taxonomy Codes

  • Taxonomy code: 320900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com