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General NPI Number Information
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NPI Number | 1003066176
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Entity Type | Organization
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Legal Business Name | MACON COUNTY COMMISSION FOR DEVELOPMENTALLY DISABLED CITIZENS
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Dates
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Enumeration Date | 09/25/2008
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Last Update Date | 09/25/2008
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Provider Practice Location Address
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Address Line | 302 N ROLLINS ST STE B
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City | MACON
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State | MO
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Zip | 63552-1596
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Country | US
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Telephone | 660-385-6325
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Fax | 660-385-6325
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Provider Business Mailing Address
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Address Line | 302 N ROLLINS ST STE B P.O. BOX 524
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City | MACON
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State | MO
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Zip | 63552-1596
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Country | US
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Telephone | 660-385-6325
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Fax | 660-385-6325
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Authorized Official
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Title or Position | CHAIRMAN
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Name | MRS. JANICE VANSICKLE
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Credential |
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Telephone | 660-385-6325
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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