MEDICARE: WARREN COUNTY DEVELOPMENTAL DISABILITIES BOARD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1417243130
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WARREN COUNTY DEVELOPMENTAL DISABILITIES BOARD

Provider Business Mailing Address
First Line	:	105 E BOONESLICK RD
Second Line	:
City	:	WARRENTON
State	:	MO
Zip	:	63383-2003
Country	:	US
Telephone Number	:	636-456-7518
Fax Number	:	636-456-2303

Provider Business Practice Location Address
First Line	:	105 E BOONESLICK RD
Second Line	:
City	:	WARRENTON
State	:	MO
Zip	:	63383-2003
Country	:	US
Telephone Number	:	636-456-7518
Fax Number	:	636-456-2303

Authorized Official
Title or Position	:	SB 40 DIRECTOR
Name	:	MS. ANITA M CONTRERAS
Credential	:
Telephone Number	:	636-456-7518

Provider Enumeration Date	:	06/21/2011
Last Update Date	:	06/21/2011

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