Healthcare Provider Details

I. General information

NPI: 1336222173
Provider Name (Legal Business Name): OSAGE COUNTY COMMUNITY LIVING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 10/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1006 E JEFFERSON ST
LINN MO
65051-9710
US

IV. Provider business mailing address

PO BOX 913 1006 EAST JEFFERSON ST
LINN MO
65051-0913
US

V. Phone/Fax

Practice location:
  • Phone: 573-897-2991
  • Fax: 573-897-4763
Mailing address:
  • Phone: 573-897-2991
  • Fax: 573-897-4763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MRS. CATHY J MCCUSKEY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 573-897-2991