Provider Demographics
NPI:1093870768
Name:MARANATHA SERVICES OF RAY COUNTY INC.
Entity Type:Organization
Organization Name:MARANATHA SERVICES OF RAY COUNTY INC.
Other - Org Name:MARANATHA CARE SERVICES INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:SPIRES
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:816-470-7295
Mailing Address - Street 1:11387 PETTIS RD
Mailing Address - Street 2:
Mailing Address - City:ORRICK
Mailing Address - State:MO
Mailing Address - Zip Code:64077-8134
Mailing Address - Country:US
Mailing Address - Phone:816-470-7295
Mailing Address - Fax:816-470-7295
Practice Address - Street 1:11387 PETTIS RD
Practice Address - Street 2:
Practice Address - City:ORRICK
Practice Address - State:MO
Practice Address - Zip Code:64077-8134
Practice Address - Country:US
Practice Address - Phone:816-470-7295
Practice Address - Fax:816-470-7295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1594-9502320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities