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JACKSON GROUP HOME LLC
NPI 1588946370
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities in Hannibal, MO

Active since September 16, 2011
18 RIDGEWOOD DR, HANNIBAL, MO 63401(573) 221-4671(573) 221-4671 Get Directions Write a Review

NPPES record last updated: April 9, 2017. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Jackson Group Home Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JACKSON GROUP HOME LLC (NPI 1588946370), doing business as Jackson Group Home, is a healthcare organization registered as a community based residential treatment facility, intellectual and/or developmental disabilities in Hannibal, Missouri and active in the NPI registry since September 2011. The organization lists Lora L Culp, Owner/operator, as its authorized official.

NPPES Registry Identity

NPI1588946370
Entity TypeOrganization
Primary Taxonomy320900000X
Legal Business NameJACKSON GROUP HOME LLC
Location Address18 RIDGEWOOD DRHannibal, MO 63401-3056
Mailing Address18 Ridgewood DrHannibal, MO 63401-3056 · (573) 221-4671 · Fax (573) 221-4671
Phone(573) 221-4671
Fax(573) 221-4671
Organization SubpartNo
Authorized OfficialLora L CulpOwner/operator · (573) 221-4671
Enumeration DateSeptember 16, 2011
Last NPPES UpdateApril 9, 2017
✔ NPI 1588946370 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCommunity Based Residential Treatment Facility, Intellectual and/or Developmental DisabilitiesResidential Treatment Facilities
Taxonomy Code320900000X
License✔ Licensed in MO · 2500-12463
Definition
A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities.
18 RIDGEWOOD DR, Hannibal, MO 63401
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Other Names 1

Former Legal Business NameJackson Group Home

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JACKSON GROUP HOME LLC
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
18 RIDGEWOOD DR
HANNIBAL, MO 63401
Marion County (573) 221-4671

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jackson Group Home LLC's NPI number?

The NPI number for Jackson Group Home LLC is 1588946370. It was assigned to this organization in the NPPES registry on September 16, 2011. The provider was formerly known as Jackson Group Home.

Where is Jackson Group Home LLC located?

Jackson Group Home LLC is located at 18 Ridgewood Dr, Hannibal, MO 63401. The listed phone number is (573) 221-4671.

What is Jackson Group Home LLC's specialty?

The primary specialty registered for this NPI is Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities with taxonomy code 320900000X.

When was this NPI record last updated?

The NPPES record for Jackson Group Home LLC was last updated on April 9, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.