Provider Demographics
NPI:1730468901
Name:TOMLONSON ISL
Entity Type:Organization
Organization Name:TOMLONSON ISL
Other - Org Name:TOMLONSON GROUP CARE HOME
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:TOMLONSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-827-1419
Mailing Address - Street 1:846 MITCHELL RD
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301-2120
Mailing Address - Country:US
Mailing Address - Phone:660-851-0400
Mailing Address - Fax:660-851-0484
Practice Address - Street 1:846 MITCHELL RD
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-2120
Practice Address - Country:US
Practice Address - Phone:660-851-0400
Practice Address - Fax:660-851-0484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-05
Last Update Date:2011-08-05
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