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NPI Code Detail

MEDICARE: BOONE COUNTY FAMILY RESOURCES

MEDICARE: BOONE COUNTY FAMILY RESOURCES
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
1320900000XIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number : 1760502140
Entity Type Code : Organization
Provider Name (Legal Business Name) : BOONE COUNTY FAMILY RESOURCES
Provider Business Mailing Address
First Line : 1209 E WALNUT ST
Second Line :
City : COLUMBIA
State : MO
Zip : 65201-4944
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1209 E WALNUT ST
Second Line :
City : COLUMBIA
State : MO
Zip : 65201-4944
Country : US
Telephone Number : 573-874-1995
Fax Number :
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : LES WAGNER
Credential :
Telephone Number : 573-874-1995
Provider Enumeration Date : 03/30/2007
Last Update Date : 08/22/2020

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Directions to “BOONE COUNTY FAMILY RESOURCES ” Practice Location

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