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General NPI Number Information
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NPI Number | 1902067184
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Entity Type | Organization
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Legal Business Name | BOYS & GIRLS TOWN OF MISSOURI
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Dates
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Enumeration Date | 06/20/2008
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Last Update Date | 06/20/2008
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Provider Practice Location Address
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Address Line | 4304 S BEARFIELD RD
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City | COLUMBIA
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State | MO
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Zip | 65201-9557
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Country | US
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Telephone | 573-874-8686
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 189
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City | SAINT JAMES
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State | MO
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Zip | 65559-0189
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | VINCE HILLYER
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Credential |
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Telephone | 573-265-3251
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | 2000163689
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License Number State | MO
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