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General NPI Number Information
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NPI Number | 1225219512
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Entity Type | Organization
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Legal Business Name | DEVELOPMENTAL DISABILITIES RESOURCE BOARD OF CLAY COUNTY
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Dates
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Enumeration Date | 11/15/2007
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Last Update Date | 11/15/2007
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Provider Practice Location Address
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Address Line | 920 KENT ST SUITE B
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City | LIBERTY
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State | MO
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Zip | 64068-2237
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Country | US
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Telephone | 816-792-5255
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Fax | 816-792-1818
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Provider Business Mailing Address
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Address Line | 920 KENT ST SUITE B
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City | LIBERTY
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State | MO
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Zip | 64068-2237
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Country | US
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Telephone | 816-792-5255
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Fax | 816-792-1818
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. CHARLES WASHBURN
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Credential |
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Telephone | 816-792-5255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | 0679143
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License Number State | MO
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