Provider Demographics
NPI:1073931465
Name:RURAL ADVOCATES FOR INDEPENDENT LIVING
Entity Type:Organization
Organization Name:RURAL ADVOCATES FOR INDEPENDENT LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-395-7001
Mailing Address - Street 1:205 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:MO
Mailing Address - Zip Code:63552-1402
Mailing Address - Country:US
Mailing Address - Phone:660-395-7001
Mailing Address - Fax:660-395-7004
Practice Address - Street 1:205 E 2ND ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:MO
Practice Address - Zip Code:63552-1402
Practice Address - Country:US
Practice Address - Phone:660-395-7001
Practice Address - Fax:660-395-7004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-02
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2Medicaid