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General NPI Number Information
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NPI Number | 1063639961
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Entity Type | Organization
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Legal Business Name | ENRICHMENT SERVICES OF DENT COUNTY, INC.
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Dates
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Enumeration Date | 04/20/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1900 SOUTH MAIN ST
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City | SALEM
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State | MO
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Zip | 65560-0109
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Country | US
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Telephone | 573-729-7279
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Fax | 573-729-9263
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Provider Business Mailing Address
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Address Line | 1900 SOUTH MAIN ST. P.O. BOX 109
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City | SALEM
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State | MO
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Zip | 65560-0109
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | SUSAN E. LOOP
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Credential |
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Telephone | 573-729-7279
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | 0679356
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License Number State | MO
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