Healthcare Provider Details

I. General information

NPI: 1063586519
Provider Name (Legal Business Name): CHILD ABUSE & NEGLECT EMERGENCY SHELTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 TOWNE DR
COLUMBIA MO
65202-2339
US

IV. Provider business mailing address

1611 TOWNE DR
COLUMBIA MO
65202-2339
US

V. Phone/Fax

Practice location:
  • Phone: 573-474-6600
  • Fax: 573-474-5992
Mailing address:
  • Phone: 573-474-6600
  • Fax: 573-474-5992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number242366
License Number StateMO

VIII. Authorized Official

Name: JAN STOCK
Title or Position: EXECUTIVE DIRECTOR
Credential: L.P.C.
Phone: 573-474-6600