Provider Demographics
NPI: | 1457629040 |
---|---|
Name: | RANDOLPH COUNTY DEVELOPMENTAL DISABILITY RESOURCES |
Entity Type: | Organization |
Organization Name: | RANDOLPH COUNTY DEVELOPMENTAL DISABILITY RESOURCES |
Other - Org Name: | RANDOLPH COUNTY DEVELOPMENTAL DISABILITY SERVICES |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | EXECUTIVE DIRECTOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JULIE |
Authorized Official - Middle Name: | L |
Authorized Official - Last Name: | DOUGHERTY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 660-269-8875 |
Mailing Address - Street 1: | PO BOX 1008 |
Mailing Address - Street 2: | |
Mailing Address - City: | MOBERLY |
Mailing Address - State: | MO |
Mailing Address - Zip Code: | 65270-0975 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 660-269-8875 |
Mailing Address - Fax: | 660-269-9621 |
Practice Address - Street 1: | 628 N MORLEY ST |
Practice Address - Street 2: | |
Practice Address - City: | MOBERLY |
Practice Address - State: | MO |
Practice Address - Zip Code: | 65270-2523 |
Practice Address - Country: | US |
Practice Address - Phone: | 660-269-8875 |
Practice Address - Fax: | 660-269-9621 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2011-12-09 |
Last Update Date: | 2019-06-11 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251B00000X | Agencies | Case Management |