Organization Name: | CAMDEN COUNTY SENATE BILL 40 BOARD |
NPI Number: | 1548307713 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | BOONE CALEB WAGNER (EXECUTIVE DIRECTOR) |
Mailing Address: | 100 3rd Street Camdenton |
State: | MO US |
Postal Code: | 65020 |
Phone Number: | 5733179233 |
Fax Number: | 5733179332 |
NPI Enumeration Date: | 01/30/2007 |
NPI Last Update Date: | 10/05/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 320900000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Residential Treatment Facilities |
Taxonomy Classification: | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
Taxonomy Specialization: | |
Taxonomy Definition: | A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. |