Healthcare Provider Details

I. General information

NPI: 1972339554
Provider Name (Legal Business Name): CINTHIA RATLIFF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2024
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 S ODELL AVE STE 102
MARSHALL MO
65340-2642
US

IV. Provider business mailing address

1060 S ODELL AVE STE 102
MARSHALL MO
65340-2642
US

V. Phone/Fax

Practice location:
  • Phone: 660-631-3153
  • Fax:
Mailing address:
  • Phone: 660-631-3153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number2026029586
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: