Provider Demographics
NPI:1033328455
Name:SHANNON'S NEIGHBORHOOD CENTER FOR HANDICAPPED CITIZEN'S, INC
Entity Type:Organization
Organization Name:SHANNON'S NEIGHBORHOOD CENTER FOR HANDICAPPED CITIZEN'S, INC
Other - Org Name:SHANNON'S NEIGHBORHOOD DBA CORA LANE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACCOUNTANT
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:A
Authorized Official - Last Name:WORD
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:573-547-4475
Mailing Address - Street 1:411 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PERRYVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63775-1317
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:40 CORA LN
Practice Address - Street 2:
Practice Address - City:PERRYVILLE
Practice Address - State:MO
Practice Address - Zip Code:63775-8845
Practice Address - Country:US
Practice Address - Phone:573-547-5254
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility