Healthcare Provider Details

I. General information

NPI: 1093855314
Provider Name (Legal Business Name): LINDA ORDWAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 06/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 N DOZIER STATION RD
COLUMBIA MO
65202-7798
US

IV. Provider business mailing address

1250 N DOZIER STATION RD
COLUMBIA MO
65202-7798
US

V. Phone/Fax

Practice location:
  • Phone: 573-256-6155
  • Fax: 573-256-6156
Mailing address:
  • Phone: 573-256-6155
  • Fax: 573-256-6156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number1849496
License Number StateMO

VIII. Authorized Official

Name: GREG ORDWAY
Title or Position: DIRECTOR
Credential:
Phone: 573-256-6155