Healthcare Provider Details

I. General information

NPI: 1619146362
Provider Name (Legal Business Name): AUDRAIN HANDICAPPED SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2008
Last Update Date: 02/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 E JACKSON ST
MEXICO MO
65265-2823
US

IV. Provider business mailing address

308 E JACKSON ST
MEXICO MO
65265-2823
US

V. Phone/Fax

Practice location:
  • Phone: 573-581-8210
  • Fax:
Mailing address:
  • Phone: 573-581-8210
  • Fax:

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: TIMOTHY M CREWS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 573-581-8210