Organization Name: | SHANAHAN GROUP HOME |
NPI Number: | 1922152040 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DEBRA LOUISE SHANAHAN (PROVIDER) |
Mailing Address: | 2204 Gambrell St Greenwood |
State: | MO US |
Postal Code: | 640349618 |
Phone Number: | 8165377638 |
Fax Number: | 8165377941 |
NPI Enumeration Date: | 01/23/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 320600000X |
License Number: | 3206000000X |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Residential Treatment Facilities |
Taxonomy Classification: | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
Taxonomy Specialization: | |
Taxonomy Definition: | A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently. |