MEDICARE: NODAWAY COUNTY SERVICES FOR THE DEVELOPMENTALLY DISABLED, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency	5430-12830	MO

General Provider Information

NPI Number	:	1477829224
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NODAWAY COUNTY SERVICES FOR THE DEVELOPMENTALLY DISABLED, INC.

Provider Business Mailing Address
First Line	:	122 E LIEBER ST
Second Line	:	PO BOX 454
City	:	MARYVILLE
State	:	MO
Zip	:	64468-2617
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	122 E LIEBER ST
Second Line	:
City	:	MARYVILLE
State	:	MO
Zip	:	64468-2617
Country	:	US
Telephone Number	:	660-582-7113
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MARK PARRA
Credential	:
Telephone Number	:	660-582-7113

Provider Enumeration Date	:	03/27/2012
Last Update Date	:	05/27/2026

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