Provider Demographics
NPI:1205015096
Name:DEVELOPMENTAL SERVICES OF MISSOURI, INC
Entity Type:Organization
Organization Name:DEVELOPMENTAL SERVICES OF MISSOURI, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:KANTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-202-5890
Mailing Address - Street 1:578 BLUE SAGE BLVD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68521-6628
Mailing Address - Country:US
Mailing Address - Phone:402-202-5890
Mailing Address - Fax:402-435-8801
Practice Address - Street 1:578 BLUE SAGE BLVD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68521-6628
Practice Address - Country:US
Practice Address - Phone:402-202-5890
Practice Address - Fax:402-435-8801
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLLABORATIVE INDUSTRIES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities