Provider Demographics
NPI:1417433301
Name:EFFIE SHURTZ GROUP HOME
Entity Type:Organization
Organization Name:EFFIE SHURTZ GROUP HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EFFIE
Authorized Official - Middle Name:P
Authorized Official - Last Name:SHURTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-683-0164
Mailing Address - Street 1:153 COUNTY RD 411
Mailing Address - Street 2:
Mailing Address - City:EAST PRAIRIE
Mailing Address - State:MO
Mailing Address - Zip Code:63845
Mailing Address - Country:US
Mailing Address - Phone:573-683-0164
Mailing Address - Fax:573-649-9411
Practice Address - Street 1:153 COUNTY RD 411
Practice Address - Street 2:
Practice Address - City:EAST PRAIRIE
Practice Address - State:MO
Practice Address - Zip Code:63845
Practice Address - Country:US
Practice Address - Phone:573-683-0164
Practice Address - Fax:573-649-9411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-14
Last Update Date:2018-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOEC-0762-0616320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities