Healthcare Provider Details

I. General information

NPI: 1225160187
Provider Name (Legal Business Name): CALLAWAY COUNTY SPECIAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 W CHESTNUT ST
FULTON MO
65251-1201
US

IV. Provider business mailing address

911 S BUSINESS 54
FULTON MO
65251-1406
US

V. Phone/Fax

Practice location:
  • Phone: 573-642-9112
  • Fax:
Mailing address:
  • Phone: 573-642-1792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. CHARKES SNOW
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 573-642-1792