Provider Demographics
NPI:1164615530
Name:RAY COUNTY BOARD OF SERVICES
Entity Type:Organization
Organization Name:RAY COUNTY BOARD OF SERVICES
Other - Org Name:RAY COUNTY SB 40 TCM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:BOND
Authorized Official - Suffix:
Authorized Official - Credentials:EDS
Authorized Official - Phone:816-470-7140
Mailing Address - Street 1:200 N COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:MO
Mailing Address - Zip Code:64085-1604
Mailing Address - Country:US
Mailing Address - Phone:816-470-7140
Mailing Address - Fax:816-776-3383
Practice Address - Street 1:200 N COLLEGE ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:MO
Practice Address - Zip Code:64085-1604
Practice Address - Country:US
Practice Address - Phone:816-470-7140
Practice Address - Fax:816-776-3383
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RAY COUNTY BOARD OF SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-20
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO856259601Medicaid
MO1386782696Medicaid