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General NPI Number Information
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NPI Number | 1730333931
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Entity Type | Organization
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Legal Business Name | MONITEAU COUNTY SENATE BILL 40 BOARD
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Dates
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Enumeration Date | 11/14/2008
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Last Update Date | 11/14/2008
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Provider Practice Location Address
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Address Line | 151 W WILKES ST
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City | CALIFORNIA
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State | MO
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Zip | 65018-1367
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Country | US
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Telephone | 573-796-2101
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Fax |
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Provider Business Mailing Address
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Address Line | 1509 INDUSTRIAL PARK DR
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City | CALIFORNIA
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State | MO
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Zip | 65018-1883
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Country | US
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Telephone | 573-796-6131
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Fax |
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Authorized Official
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Title or Position | BOARD CHAIR
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Name | DR. JAMES CANTER
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Credential |
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Telephone | 573-230-6426
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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