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General NPI Number Information
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NPI Number | 1679771430
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Entity Type | Organization
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Legal Business Name | GOOD SAMARITAN BOYS RANCH
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Dates
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Enumeration Date | 07/03/2007
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Last Update Date | 10/26/2022
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Provider Practice Location Address
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Address Line | 5549 N HIGHWAY 13
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City | BRIGHTON
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State | MO
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Zip | 65617-8112
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Country | US
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Telephone | 417-376-2238
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 617
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City | BRIGHTON
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State | MO
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Zip | 65617-0617
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Country | US
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Telephone | 417-376-2238
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF INFORMATION TECHNOLOGY
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Name | MARK ANDREW MAINE
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Credential |
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Telephone | 417-376-2238
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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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 | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number |
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License Number State |
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