Healthcare Provider Details

I. General information

NPI: 1235250440
Provider Name (Legal Business Name): FERNDALE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 06/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15677 COUNTY ROAD 2430
ST JAMES MO
65559-8210
US

IV. Provider business mailing address

15677 COUNTY ROAD 2430
ST JAMES MO
65559-8210
US

V. Phone/Fax

Practice location:
  • Phone: 573-265-3344
  • Fax: 573-265-1119
Mailing address:
  • Phone: 573-265-3344
  • Fax: 573-265-1119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MRS. RHONDA JEAN GILBERT
Title or Position: HOUSE MANAGER
Credential:
Phone: 573-265-3344