Provider Demographics
NPI:1275681959
Name:AVENUE CITY R-IX SCHOOL
Entity Type:Organization
Organization Name:AVENUE CITY R-IX SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:LEO
Authorized Official - Last Name:ARCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-662-2305
Mailing Address - Street 1:18069 HWY 169
Mailing Address - Street 2:P.O. BOX 295
Mailing Address - City:COSY
Mailing Address - State:MO
Mailing Address - Zip Code:64436-8115
Mailing Address - Country:US
Mailing Address - Phone:816-662-2305
Mailing Address - Fax:816-662-3201
Practice Address - Street 1:18069 HWY 169
Practice Address - Street 2:
Practice Address - City:COSBY
Practice Address - State:MO
Practice Address - Zip Code:64436-8115
Practice Address - Country:US
Practice Address - Phone:816-662-2305
Practice Address - Fax:816-662-3201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty