Provider Demographics
NPI:1235250440
Name:FERNDALE INC
Entity Type:Organization
Organization Name:FERNDALE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOUSE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-265-3344
Mailing Address - Street 1:15677 COUNTY ROAD 2430
Mailing Address - Street 2:
Mailing Address - City:ST JAMES
Mailing Address - State:MO
Mailing Address - Zip Code:65559-8210
Mailing Address - Country:US
Mailing Address - Phone:573-265-3344
Mailing Address - Fax:573-265-1119
Practice Address - Street 1:15677 COUNTY ROAD 2430
Practice Address - Street 2:
Practice Address - City:ST JAMES
Practice Address - State:MO
Practice Address - Zip Code:65559-8210
Practice Address - Country:US
Practice Address - Phone:573-265-3344
Practice Address - Fax:573-265-1119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO856796503Medicaid