Provider Demographics
NPI:1417243130
Name:WARREN COUNTY DEVELOPMENTAL DISABILITIES BOARD
Entity Type:Organization
Organization Name:WARREN COUNTY DEVELOPMENTAL DISABILITIES BOARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SB 40 DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CONTRERAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-456-7518
Mailing Address - Street 1:105 E BOONESLICK RD
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63383-2003
Mailing Address - Country:US
Mailing Address - Phone:636-456-7518
Mailing Address - Fax:636-456-2303
Practice Address - Street 1:105 E BOONESLICK RD
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:MO
Practice Address - Zip Code:63383-2003
Practice Address - Country:US
Practice Address - Phone:636-456-7518
Practice Address - Fax:636-456-2303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management