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General NPI Number Information
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NPI Number | 1992932354
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Entity Type | Organization
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Legal Business Name | CALLAWAY COUNTY SPECIAL SERVICES
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Dates
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Enumeration Date | 06/12/2009
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Last Update Date | 06/12/2009
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Provider Practice Location Address
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Address Line | 911 S BUSINESS 54
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City | FULTON
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State | MO
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Zip | 65251-1406
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Country | US
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Telephone | 573-642-1792
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Fax | 573-642-2415
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Provider Business Mailing Address
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Address Line | 911 S BUSINESS 54
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City | FULTON
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State | MO
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Zip | 65251-1406
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Country | US
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Telephone | 573-642-1792
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Fax | 573-642-2415
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. CHARLES E. SNOW
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Credential | M. S.
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Telephone | 573-642-1792
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | N00859770
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License Number State | MO
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