Healthcare Provider Details

I. General information

NPI: 1275687097
Provider Name (Legal Business Name): B. J. PRICE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 06/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 N GRAND AVE
DONIPHAN MO
63935-1409
US

IV. Provider business mailing address

HC 4 BOX 85A
DONIPHAN MO
63935-9307
US

V. Phone/Fax

Practice location:
  • Phone: 573-996-5413
  • Fax: 573-996-7508
Mailing address:
  • Phone: 573-996-5413
  • Fax: 573-996-7508

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 TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number1769-9716
License Number StateMO

VIII. Authorized Official

Name: MR. SAMUEL EMMETT PRICE
Title or Position: PRESIDENT
Credential:
Phone: 573-996-5413