Healthcare Provider Details

I. General information

NPI: 1427352640
Provider Name (Legal Business Name): CENTRAL MISSOURI COMMUNITY ACTION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2011
Last Update Date: 01/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 N PROVIDENCE RD STE. B
COLUMBIA MO
65203-4359
US

IV. Provider business mailing address

807 N PROVIDENCE RD STE. B
COLUMBIA MO
65203-4359
US

V. Phone/Fax

Practice location:
  • Phone: 573-443-8706
  • Fax: 573-874-6993
Mailing address:
  • Phone: 573-443-8706
  • Fax: 573-874-6993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MERNELL KING
Title or Position: EARLY CHILDHOOD PROGRAMS DIRECTOR
Credential:
Phone: 573-443-8706