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General NPI Number Information
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NPI Number | 1508060336
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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 | 06/14/2007
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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 S MAIN
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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 | PO 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 | 573-729-7279
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Fax | 573-729-9263
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. 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 | 604
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License Number State | MO
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