Tri-County Community Individualized Supported Living, LLC

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

TRI-COUNTY COMMUNITY INDIVIDUALIZED SUPPORTED LIVING, LLC

Practice address

46 E State Highway 162
Portageville, MO 63873-9177

Phone

(573) 391-8031

Fax

(573) 391-8050

NPI assigned

Dec 8, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ladonna Jean Williams, DNP

Title

Owner/Provider

Phone

(573) 391-8031

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1638921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1638921600000",
    "number": "1700545670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "46 E STATE HIGHWAY 162",
            "city": "PORTAGEVILLE",
            "state": "MO",
            "postal_code": "638739177",
            "telephone_number": "573-391-8031",
            "fax_number": "573-391-8050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "46 E STATE HIGHWAY 162",
            "city": "PORTAGEVILLE",
            "state": "MO",
            "postal_code": "638739177",
            "telephone_number": "573-391-8031",
            "fax_number": "573-391-8050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI-COUNTY COMMUNITY INDIVIDUALIZED SUPPORTED LIVING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-08",
        "last_updated": "2021-12-08",
        "certification_date": "2021-12-08",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "LADONNA",
        "authorized_official_middle_name": "JEAN",
        "authorized_official_title_or_position": "OWNER/PROVIDER",
        "authorized_official_telephone_number": "573-391-8031",
        "authorized_official_credential": "DNP"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amy Kellams Stinnett, FNP
• T M Swinger & D V McKillip, PTR
• Zarria Joi Taylor
• Abby Dawn Treece
• Tri-County Community Clinic, LLC
• Lorna A Turnage, NP
• Bryce Alexander Wallace, PHARMD
• Ladonna Jean Williams, FNP

• All providers in Portageville, MO
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.