| Individualized Solutions, Llc | |
|
2301 Idlewood Rd Jefferson City MO 65109-2119 | |
| (573) 418-1677 | |
| Not Available |
| Full Name | Individualized Solutions, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2301 Idlewood Rd, Jefferson City, Missouri |
| Authorized Official Name and Position | Gary E Brotherton (BUSINESS CONSULTANT) |
| Authorized Official Contact | 5732680967 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Individualized Solutions, Llc 2301 Idlewood Rd Jefferson City MO 65109-2119 Ph: (573) 418-1677 | Individualized Solutions, Llc 2301 Idlewood Rd Jefferson City MO 65109-2119 Ph: (573) 418-1677 |
| NPI Number | 1962172304 |
|---|---|
| Provider Enumeration Date | 09/16/2021 |
| Last Update Date | 09/16/2021 |
| Certification Date | 09/16/2021 |
| Medicare PECOS PAC ID | 1153728571 |
|---|---|
| Medicare Enrollment ID | O20210927002569 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962172304 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| Provider Name | Rita Denome |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1538660501 PECOS PAC ID: 8123380086 Enrollment ID: I20191119001570 |
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