Healthcare Provider Details

I. General information

NPI: 1932231651
Provider Name (Legal Business Name): SEMO ALLIANCE FOR DISABILITY INDEPENDENCE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 01/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1913 RUSMAR ST
CAPE GIRARDEAU MO
63703-7623
US

IV. Provider business mailing address

1913 RUSMAR ST
CAPE GIRARDEAU MO
63703-7623
US

V. Phone/Fax

Practice location:
  • Phone: 573-651-6464
  • Fax: 573-651-6565
Mailing address:
  • Phone: 573-651-6464
  • Fax: 573-651-6565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARYANN GUDERMUTH
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 573-651-6464