Provider Demographics
NPI:1912035981
Name:SALMONS ISL
Entity Type:Organization
Organization Name:SALMONS ISL
Other - Org Name:JANA REA SALMONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANA
Authorized Official - Middle Name:REA
Authorized Official - Last Name:SALMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-893-2377
Mailing Address - Street 1:2434 SCENIC DR
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65101-3912
Mailing Address - Country:US
Mailing Address - Phone:573-893-2377
Mailing Address - Fax:
Practice Address - Street 1:2434 SCENIC DR
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65101-3912
Practice Address - Country:US
Practice Address - Phone:573-893-2377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO8002087320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities