Healthcare Provider Details

I. General information

NPI: 1518198043
Provider Name (Legal Business Name): BENTON COUNTY ADVOCATES FOR DEVELOPMENTAL DISABILITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2009
Last Update Date: 07/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1661 COMMERCIAL STREET
WARSAW MO
65355
US

IV. Provider business mailing address

PO BOX 11
WARSAW MO
65355-0011
US

V. Phone/Fax

Practice location:
  • Phone: 660-438-3200
  • Fax: 660-438-2459
Mailing address:
  • Phone: 660-438-3200
  • Fax: 660-438-2459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: JODI A ORTON
Title or Position: PRESIDENT
Credential:
Phone: 660-438-3200