Jackson Style Agency, LLC

NPI #1386701613 in Grandview, Missouri

Provider Information

NPI Number: 1386701613
Entity Type: Organization
Organization Name: Jackson Style Agency, LLC
Primary Specialty: Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Enumeration Date: Jan 3, 2007
Last Updated: Jul 10, 2007

Practice Location

Address: 213 BLUE RIDGE EXT
City: Grandview
State: Missouri
ZIP Code: 64030-1603
Phone: (816) 765-9990

Authorized Official

Name: MR. CLEOTHA JACKSON
Title: ASSISTANT ADMINISTRATOR
Phone: (816) 765-9990

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Residential Treatment Facility, Intellectual and/or Developmental Disabilities	320600000X
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities	320900000X	Primary

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