Healthcare Provider Details

I. General information

NPI: 1558498345
Provider Name (Legal Business Name): CHARITON VALLEY ASSOCIATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 03/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 S HIGH ST
KIRKSVILLE MO
63501-4764
US

IV. Provider business mailing address

1905 S HIGH ST
KIRKSVILLE MO
63501-4764
US

V. Phone/Fax

Practice location:
  • Phone: 660-665-1111
  • Fax:
Mailing address:
  • Phone: 660-665-1111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. TERRY COMBS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 660-665-1111