Healthcare Provider Details

I. General information

NPI: 1295893089
Provider Name (Legal Business Name): GRUNDY COUNTY ASSOCIATION FOR HANDICAPPED CITIZENS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 PRINCETON RD
TRENTON MO
64683-3059
US

IV. Provider business mailing address

2600 PRINCETON RD
TRENTON MO
64683-3059
US

V. Phone/Fax

Practice location:
  • Phone: 660-359-6655
  • Fax: 660-359-6098
Mailing address:
  • Phone: 660-359-6655
  • Fax: 660-359-6098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number1605-9532
License Number StateMO

VIII. Authorized Official

Name: MS. MARY LOU CRAWFORD
Title or Position: PRESIDENT
Credential:
Phone: 660-359-2851