Healthcare Provider Details

I. General information

NPI: 1497181614
Provider Name (Legal Business Name): DISABLED CITIZENS ALLIANCE FOR INDEPENDENCE FOUNDATION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2013
Last Update Date: 02/25/2020
Certification Date: 02/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 SOUTH HWY 49
VIBURNUM MO
65566
US

IV. Provider business mailing address

PO BOX 706
VIBURNUM MO
65566-0706
US

V. Phone/Fax

Practice location:
  • Phone: 573-244-5510
  • Fax: 573-244-5511
Mailing address:
  • Phone: 573-244-5510
  • Fax: 573-244-5511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
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 Code372500000X
TaxonomyChore Provider
License Number
License Number State

VIII. Authorized Official

Name: RHONDA PAYNE
Title or Position: DIRECTOR
Credential:
Phone: 573-244-5555