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General NPI Number Information
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NPI Number | 1104167923
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Entity Type | Organization
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Legal Business Name | POLK COUNTY SENATE BILL 40
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Dates
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Enumeration Date | 03/04/2013
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Last Update Date | 05/14/2013
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Provider Practice Location Address
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Address Line | 4746 S 131ST RD
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City | BOLIVAR
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State | MO
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Zip | 65613-2886
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Country | US
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Telephone | 417-777-3000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 944
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City | BOLIVAR
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State | MO
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Zip | 65613-0944
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Country | US
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Telephone | 417-777-3000
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Fax |
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Authorized Official
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Title or Position | POLK COUNTY BOARD CHAIR
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Name | ARLENE LEAR
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Credential |
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Telephone | 417-777-3000
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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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