Provider Demographics
NPI:1366623647
Name:CHARITON CO. SHELTERED WORKSHOP, INC.
Entity Type:Organization
Organization Name:CHARITON CO. SHELTERED WORKSHOP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:NANNEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-288-3693
Mailing Address - Street 1:30109 CLEVE IMAN LN
Mailing Address - Street 2:
Mailing Address - City:KEYTESVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65261-2600
Mailing Address - Country:US
Mailing Address - Phone:660-288-3693
Mailing Address - Fax:660-288-2213
Practice Address - Street 1:30109 CLEVE IMAN LN
Practice Address - Street 2:
Practice Address - City:KEYTESVILLE
Practice Address - State:MO
Practice Address - Zip Code:65261-2600
Practice Address - Country:US
Practice Address - Phone:660-288-3693
Practice Address - Fax:660-288-2213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services