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General NPI Number Information
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NPI Number | 1528234465
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Entity Type | Organization
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Legal Business Name | PERRY COUNTY BOARD FOR THE DEVELOPMENTALLY DISABLED
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Dates
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Enumeration Date | 04/30/2008
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Last Update Date | 01/21/2009
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Provider Practice Location Address
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Address Line | 618 INDUSTRIAL DR SUITE A
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City | PERRYVILLE
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State | MO
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Zip | 63775-1200
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Country | US
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Telephone | 573-547-6639
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Fax | 573-517-0401
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Provider Business Mailing Address
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Address Line | 618 INDUSTRIAL DR SUITE A
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City | PERRYVILLE
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State | MO
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Zip | 63775-1200
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Country | US
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Telephone | 573-547-6639
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Fax | 573-517-0401
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Authorized Official
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Title or Position | BOARD PRESIDENT SENATE BILL 40
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Name | MR. DAVE RICHARDET
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Credential |
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Telephone | 573-547-2158
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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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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 251B0000X
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License Number State |
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