Healthcare Provider Details

I. General information

NPI: 1760576425
Provider Name (Legal Business Name): SEMO ALLIANCE FOR DISABILITY INDEPENDENCE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 05/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 S BROADVIEW ST STE 12
CAPE GIRARDEAU MO
63703-5702
US

IV. Provider business mailing address

121 S BROADVIEW ST STE 12
CAPE GIRARDEAU MO
63703-5702
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 TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

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