Provider Demographics
NPI:1366624603
Name:PERSONAL TOUCH
Entity Type:Organization
Organization Name:PERSONAL TOUCH
Other - Org Name:JACKSON GROUP HOME
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:EARNESTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-688-2002
Mailing Address - Street 1:PO BOX 176
Mailing Address - Street 2:
Mailing Address - City:LILBOURN
Mailing Address - State:MO
Mailing Address - Zip Code:63862-0176
Mailing Address - Country:US
Mailing Address - Phone:573-688-2002
Mailing Address - Fax:573-688-5174
Practice Address - Street 1:7570 US HIGHWAY 61
Practice Address - Street 2:
Practice Address - City:NEW MADRID
Practice Address - State:MO
Practice Address - Zip Code:63869-9183
Practice Address - Country:US
Practice Address - Phone:573-688-2002
Practice Address - Fax:573-688-5174
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JACKSON GROUP HOME
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-28
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities