Healthcare Provider Details

I. General information

NPI: 1003930520
Provider Name (Legal Business Name): SPECIALTY PRODUCTS & SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 08/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 S WALNUT ST
DEXTER MO
63841-2146
US

IV. Provider business mailing address

402 S WALNUT ST
DEXTER MO
63841-2146
US

V. Phone/Fax

Practice location:
  • Phone: 573-624-9925
  • Fax: 573-624-9928
Mailing address:
  • Phone: 573-624-9925
  • Fax: 573-624-9928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. CHASTITY ANN COURTER
Title or Position: ADMINISTRATIVE ASSISTANT
Credential:
Phone: 573-624-9925