Healthcare Provider Details

I. General information

NPI: 1245385491
Provider Name (Legal Business Name): PARTNERS IN YOUR COMMUNITY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 03/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5085 E HIGHWAY 54
EL DORADO SPRINGS MO
64744-8589
US

IV. Provider business mailing address

PO BOX 268 5085 EAST HIGHWAY 54
EL DORADO SPRINGS MO
64744-0268
US

V. Phone/Fax

Practice location:
  • Phone: 417-876-5500
  • Fax: 417-876-5575
Mailing address:
  • Phone: 417-876-5500
  • Fax: 417-876-5575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number17550246
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number17550246
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number17550246
License Number StateMO

VIII. Authorized Official

Name: MRS. JULIE MCCULLICK
Title or Position: DIRECTOR OF SERVICES
Credential:
Phone: 417-876-5500