Provider Demographics
NPI:1073644076
Name:JEFFERSON COUNTY DEVELOPMENTAL DISBILITIES RESOURCE BOARD
Entity Type:Organization
Organization Name:JEFFERSON COUNTY DEVELOPMENTAL DISBILITIES RESOURCE BOARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOLDRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-282-4400
Mailing Address - Street 1:3655 BAPTIST PARK RD
Mailing Address - Street 2:P O BOX 97
Mailing Address - City:MAPAVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63065
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3655 BAPTIST PARK RD
Practice Address - Street 2:
Practice Address - City:MAPAVILLE
Practice Address - State:MO
Practice Address - Zip Code:63065
Practice Address - Country:US
Practice Address - Phone:636-282-4400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management