Provider Demographics
NPI:1457475626
Name:CHILDREN'S THERAPY CENTER OF PETTIS COUNTY, INC
Entity Type:Organization
Organization Name:CHILDREN'S THERAPY CENTER OF PETTIS COUNTY, INC
Other - Org Name:CENTER FOR HUMAN SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:A
Authorized Official - Last Name:GARLICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-826-4400
Mailing Address - Street 1:1500 EWING DR
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301-2396
Mailing Address - Country:US
Mailing Address - Phone:660-826-4400
Mailing Address - Fax:866-495-6424
Practice Address - Street 1:151 W WILKES ST
Practice Address - Street 2:
Practice Address - City:CALIFORNIA
Practice Address - State:MO
Practice Address - Zip Code:65018-1367
Practice Address - Country:US
Practice Address - Phone:660-826-4400
Practice Address - Fax:866-495-6424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities