Provider Demographics
NPI:1427181866
Name:HARRISON COUNTY HANDICAPPED GROUP HOME CORPORATION
Entity Type:Organization
Organization Name:HARRISON COUNTY HANDICAPPED GROUP HOME CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEGAARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-425-6300
Mailing Address - Street 1:501 S 26TH ST
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:MO
Mailing Address - Zip Code:64424-2182
Mailing Address - Country:US
Mailing Address - Phone:660-425-6300
Mailing Address - Fax:660-425-6318
Practice Address - Street 1:501 S 26TH ST
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:MO
Practice Address - Zip Code:64424-2182
Practice Address - Country:US
Practice Address - Phone:660-425-6300
Practice Address - Fax:660-425-6318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1336-9740320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities