Provider Demographics
NPI:1013041169
Name:JASPER COUNTY SHELTERED FACILITIES ASSC.
Entity Type:Organization
Organization Name:JASPER COUNTY SHELTERED FACILITIES ASSC.
Other - Org Name:COMMUNITY SUPPORT SERVICES OF MO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JHAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:HURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-624-4515
Mailing Address - Street 1:2312 ANNIE BAXTER AVE
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-0329
Mailing Address - Country:US
Mailing Address - Phone:417-624-4515
Mailing Address - Fax:417-624-9064
Practice Address - Street 1:2312 ANNIE BAXTER AVE
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-0329
Practice Address - Country:US
Practice Address - Phone:417-624-4515
Practice Address - Fax:417-624-9064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services