Provider Demographics
NPI:1356461693
Name:STODDARD COUNTY ARC GH
Entity Type:Organization
Organization Name:STODDARD COUNTY ARC GH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHESSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-624-5763
Mailing Address - Street 1:PO BOX 444
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:MO
Mailing Address - Zip Code:63841-0444
Mailing Address - Country:US
Mailing Address - Phone:573-624-5763
Mailing Address - Fax:
Practice Address - Street 1:315 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:MO
Practice Address - Zip Code:63841-2145
Practice Address - Country:US
Practice Address - Phone:573-624-5763
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities