Healthcare Provider Details

I. General information

NPI: 1437369832
Provider Name (Legal Business Name): ALLEN SUPPORTED LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 08/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RT 3 3268A
THAYER MO
65791
US

IV. Provider business mailing address

3268A RT 3
THAYER MO
65791
US

V. Phone/Fax

Practice location:
  • Phone: 417-264-2272
  • Fax:
Mailing address:
  • Phone: 417-264-2272
  • Fax:

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 Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHARLET SUE ALLEN
Title or Position: ADMINISTRATOR
Credential:
Phone: 417-264-2272