Provider Demographics
NPI:1134341647
Name:SAMUEL & JILL HIERONYMUS
Entity type:Organization
Organization Name:SAMUEL & JILL HIERONYMUS
Other - Org Name:<UNAVAIL>
Other - Org Type:
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:RN
Authorized Official - Phone:660-335-6500
Mailing Address - Street 1:507 E MARSHALL ST
Mailing Address - Street 2:PO BOX 204
Mailing Address - City:SWEET SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:65351-9759
Mailing Address - Country:US
Mailing Address - Phone:660-335-6500
Mailing Address - Fax:660-335-6656
Practice Address - Street 1:507 E MARSHALL ST
Practice Address - Street 2:
Practice Address - City:SWEET SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:65351-9759
Practice Address - Country:US
Practice Address - Phone:660-335-6500
Practice Address - Fax:660-335-6656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO033834310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility