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?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management