Provider Demographics
NPI:1154460384
Name:CLINCO SHELTERED INDUSTRIES, INC.
Entity Type:Organization
Organization Name:CLINCO SHELTERED INDUSTRIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-632-3966
Mailing Address - Street 1:1205 W GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:MO
Mailing Address - Zip Code:64429-1186
Mailing Address - Country:US
Mailing Address - Phone:816-632-3966
Mailing Address - Fax:816-632-3248
Practice Address - Street 1:1205 W GRAND AVE
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:MO
Practice Address - Zip Code:64429-1186
Practice Address - Country:US
Practice Address - Phone:816-632-3966
Practice Address - Fax:816-632-3248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
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