Healthcare Provider Details

I. General information

NPI: 1821112384
Provider Name (Legal Business Name): SERVICES FOR EXTENDED EMPLOYMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 SUGAR CREEK RD
PIEDMONT MO
63957-9607
US

IV. Provider business mailing address

6 SUGAR CREEK RD
PIEDMONT MO
63957-9607
US

V. Phone/Fax

Practice location:
  • Phone: 573-223-7705
  • Fax: 573-223-7710
Mailing address:
  • Phone: 573-223-7705
  • Fax: 573-223-7710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL S. CAMBRON
Title or Position: MANAGER
Credential:
Phone: 573-223-7705