Provider Demographics
NPI:1609179373
Name:THE LIFE OF JESUS ORGANIZATION
Entity Type:Organization
Organization Name:THE LIFE OF JESUS ORGANIZATION
Other - Org Name:GUARDIANS ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:AUGUSTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALILONU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-803-8154
Mailing Address - Street 1:14 N SPRIGG ST
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-5526
Mailing Address - Country:US
Mailing Address - Phone:573-332-1423
Mailing Address - Fax:
Practice Address - Street 1:14 N SPRIGG ST
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-5526
Practice Address - Country:US
Practice Address - Phone:573-332-1423
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-17
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services