Provider Demographics
NPI:1790138956
Name:SAMUEL AND JILL HIERONYMUS
Entity Type:Organization
Organization Name:SAMUEL AND JILL HIERONYMUS
Other - Org Name:TWIN OAKS INDEPENDENT LIVING II
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:HIERONYMUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-335-0091
Mailing Address - Street 1:PO BOX 204
Mailing Address - Street 2:
Mailing Address - City:SWEET SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:65351-0204
Mailing Address - Country:US
Mailing Address - Phone:660-335-0091
Mailing Address - Fax:660-335-0092
Practice Address - Street 1:127 TOWER DR
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:MO
Practice Address - Zip Code:65355-3439
Practice Address - Country:US
Practice Address - Phone:660-335-0091
Practice Address - Fax:660-335-0092
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAMUEL AND JILL HIERONYMUS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-07-22
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities