Healthcare Provider Details

I. General information

NPI: 1730210212
Provider Name (Legal Business Name): AUDRAIN HANDICAPPED SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 09/11/2025
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: 573-581-5204
Mailing address:
  • Phone: 573-581-8210
  • Fax: 573-581-5204

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 TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

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