Provider Demographics
NPI:1376610667
Name:PIKE COUNTY AGENCY FOR DEVELOPMENTAL DISABILITIES
Entity Type:Organization
Organization Name:PIKE COUNTY AGENCY FOR DEVELOPMENTAL DISABILITIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BETSY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:573-324-5493
Mailing Address - Street 1:900 INDEPENDENCE DR
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:MO
Mailing Address - Zip Code:63334-2440
Mailing Address - Country:US
Mailing Address - Phone:573-324-5493
Mailing Address - Fax:573-324-6391
Practice Address - Street 1:900 INDEPENDENCE DR
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:MO
Practice Address - Zip Code:63334-2440
Practice Address - Country:US
Practice Address - Phone:573-324-5493
Practice Address - Fax:573-324-6391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management