Healthcare Provider Details

I. General information

NPI: 1710810064
Provider Name (Legal Business Name): ADAIR COUNTY SB40 DEVELOPMENTAL DISABILITY BOARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 E MCPHERSON ST
KIRKSVILLE MO
63501-3557
US

IV. Provider business mailing address

314 E MCPHERSON ST
KIRKSVILLE MO
63501-3557
US

V. Phone/Fax

Practice location:
  • Phone: 660-665-9400
  • Fax: 660-665-9404
Mailing address:
  • Phone: 660-665-9400
  • Fax: 660-665-9404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: SEAN JACOB
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 660-665-9400