Tri-County Community Individualized Supported Living, LLC
NPI #1700545670 in Portageville, Missouri
Provider Information
- NPI Number
- 1700545670
- Entity Type
- Organization
- Organization Name
- Tri-County Community Individualized Supported Living, LLC
- Primary Specialty
- Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
- Enumeration Date
- Dec 8, 2021
- Last Updated
- Dec 8, 2021
Practice Location
- Address
- 46 E STATE HIGHWAY 162
- City
- Portageville
- State
- Missouri
- ZIP Code
- 63873-9177
- Phone
- (573) 391-8031
Authorized Official
- Name
- LADONNA JEAN WILLIAMS, DNP
- Title
- OWNER/PROVIDER
- Phone
- (573) 391-8031
Specialties & Taxonomy Codes
| Specialty |
|---|
| Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
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