Provider Demographics
NPI:1477697209
Name:POWDERLY AND ASSOCIATES, INC.
Entity Type:Organization
Organization Name:POWDERLY AND ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANTOINETTE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:POWDERLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-938-7044
Mailing Address - Street 1:346 LEWIS BLUFF CIR
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:MO
Mailing Address - Zip Code:63025-1638
Mailing Address - Country:US
Mailing Address - Phone:636-938-7044
Mailing Address - Fax:636-938-3883
Practice Address - Street 1:346 LEWIS BLUFF CIR
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:MO
Practice Address - Zip Code:63025-1638
Practice Address - Country:US
Practice Address - Phone:636-938-7044
Practice Address - Fax:636-938-3883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities