Provider Demographics
NPI:1407974389
Name:CINDY CHRISTAL
Entity Type:Organization
Organization Name:CINDY CHRISTAL
Other - Org Name:CLEO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:CHRISTAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-424-9275
Mailing Address - Street 1:3100 MEXICO GRAVEL RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65202-2631
Mailing Address - Country:US
Mailing Address - Phone:573-424-9275
Mailing Address - Fax:573-474-3730
Practice Address - Street 1:3100 MEXICO GRAVEL RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65202-2631
Practice Address - Country:US
Practice Address - Phone:573-424-9275
Practice Address - Fax:573-474-3730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO8000699320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities