Holistic Individual Support Living LLC
Community Based Residential Treatment Facility, Mental Illness in Jefferson City, MO. Organization (NPI-2).
NPI number1215744198
StatusActive
Last updated in NPPESDec 30, 2024
Details
- NPI
- 1215744198
- Entity type
- Organization (NPI-2)
- Legal business name
- Holistic Individual Support Living LLC
- Organization subpart
- No
- Enumeration date
- Dec 14, 2024
- Certification date
- Dec 30, 2024
- Last updated
- Dec 30, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 320800000X | Community Based Residential Treatment Facility, Mental Illness | – | – | Yes |
Other names
- Holistic (Doing Business As)
Practice location
529 Aurora AveJefferson City, MO 65101-2816
Phone 202-518-7073
Mailing address
529 Aurora AveJefferson City, MO 65101-2816
Phone 207-518-7073
Authorized official
Jovin M Bayingana
Ceo
2075187073
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