JACKSON GROUP HOME LLC NPI 1588946370

NPI Information

  • NPI: 1588946370
  • Provider Name: JACKSON GROUP HOME LLC
  • Classification: Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities - 320900000X
  • Entity Type: Organization
  • Former Legal Business Name: JACKSON GROUP HOME
  • Address: 18 RIDGEWOOD DR
    HANNIBAL, MO
    ZIP 63401
  • Phone: (573) 221-4671

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NPI Details

JACKSON GROUP HOME LLC is a community based residential treatment facility, intellectual and/or developmental disabilities in Hannibal, MO. The provider is a home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. JACKSON GROUP HOME LLC NPI is 1588946370. The provider is registered as an organization entity type.
The provider Former Legal Business Name Is Jackson Group Home.

The provider's business location address is:

18 RIDGEWOOD DR
HANNIBAL, MO
ZIP 63401-056
Phone: (573) 221-4671
Fax: (573) 221-4671

The provider's authorized official is Lora L Culp .
The authorized official title is Owner/operator and has the following contact phone number (573) 221-4671.

The enumeration date for this NPI number is 9/16/2011 and was last updated on 4/9/2017.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1320900000XCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities2500-12463MISSOURIYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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