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General NPI Number Information
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NPI Number | 1477829224
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Entity Type | Organization
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Legal Business Name | NODAWAY COUNTY SERVICES FOR THE DEVELOPMENTALLY DISABLED
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Dates
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Enumeration Date | 03/27/2012
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Last Update Date | 03/27/2012
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Provider Practice Location Address
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Address Line | 122 E LIEBER ST
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City | MARYVILLE
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State | MO
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Zip | 64468-2617
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Country | US
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Telephone | 660-582-7113
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Fax |
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Provider Business Mailing Address
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Address Line | 122 E LIEBER ST PO BOX 454
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City | MARYVILLE
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State | MO
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Zip | 64468-2617
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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 | EXECUTIVE DIRECTOR
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Name | THOMAS BEATTIE
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Credential |
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Telephone | 660-582-7113
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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 | 5430-12830
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License Number State | MO
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