MEDICARE: DEVELOPMENTAL DISABILITIES ASSISTANCE BOARD OF MONTGOMERY COUNTY

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	251C00000X	Developmentally Disabled Services Day Training Agency	6630791	MO
2	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	6743668	MO
3	332B00000X	Durable Medical Equipment & Medical Supplies	6743668	MO
4	343900000X	Non-emergency Medical Transport (VAN)	6743668	MO

General Provider Information

NPI Number	:	1770607970
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEVELOPMENTAL DISABILITIES ASSISTANCE BOARD OF MONTGOMERY COUNTY

Provider Business Mailing Address
First Line	:	230 E NORMAN ST
Second Line	:	P.O. BOX 63
City	:	MONTGOMERY CITY
State	:	MO
Zip	:	63361-1427
Country	:	US
Telephone Number	:	573-564-5045
Fax Number	:	573-564-3662

Provider Business Practice Location Address
First Line	:	117 N LYONS ST
Second Line	:
City	:	MONTGOMERY CITY
State	:	MO
Zip	:	63361-1912
Country	:	US
Telephone Number	:	573-564-3900
Fax Number	:	573-564-3662

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. DANIEL W. COLE
Credential	:
Telephone Number	:	573-564-5045

Provider Enumeration Date	:	03/16/2007
Last Update Date	:	09/11/2025

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