Provider Demographics
NPI:1497982417
Name:SAMUEL AND JILL HIERONYMUS
Entity Type:Organization
Organization Name:SAMUEL AND JILL HIERONYMUS
Other - Org Name:TWIN OAKS INDEPENDENT LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:HIERONYMUS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:660-335-6500
Mailing Address - Street 1:1001 N MILLER ST
Mailing Address - Street 2:
Mailing Address - City:SWEET SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:65351-9786
Mailing Address - Country:US
Mailing Address - Phone:660-335-0091
Mailing Address - Fax:660-335-0092
Practice Address - Street 1:1001 N MILLER ST
Practice Address - Street 2:
Practice Address - City:SWEET SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:65351-9786
Practice Address - Country:US
Practice Address - Phone:660-335-0091
Practice Address - Fax:660-335-0092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-17
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities