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General NPI Number Information
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NPI Number | 1679746382
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Entity Type | Organization
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Legal Business Name | LAFAYETTE COUNTY BOARD OF SHELTERED SERVICES
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Dates
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Enumeration Date | 04/03/2008
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Last Update Date | 04/03/2008
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Provider Practice Location Address
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Address Line | 312 W 19TH ST
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City | HIGGINSVILLE
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State | MO
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Zip | 64037-1513
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Country | US
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Telephone | 660-584-3101
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Fax | 660-584-8688
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Provider Business Mailing Address
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Address Line | 312 W 19TH ST PO BOX 48
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City | HIGGINSVILLE
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State | MO
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Zip | 64037-1513
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Country | US
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Telephone | 660-584-3101
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Fax | 660-584-8688
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MARCUS T. WHITLOCK
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Credential |
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Telephone | 660-584-3101
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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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