Provider Demographics
NPI:1518091354
Name:CITADEL ASSOCIATION, INC.
Entity Type:Organization
Organization Name:CITADEL ASSOCIATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:GEORGIA
Authorized Official - Middle Name:I
Authorized Official - Last Name:EYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-438-3736
Mailing Address - Street 1:217 E CITADEL DR
Mailing Address - Street 2:
Mailing Address - City:POTOSI
Mailing Address - State:MO
Mailing Address - Zip Code:63664-1937
Mailing Address - Country:US
Mailing Address - Phone:573-438-3736
Mailing Address - Fax:573-436-9200
Practice Address - Street 1:217 E CITADEL DR
Practice Address - Street 2:
Practice Address - City:POTOSI
Practice Address - State:MO
Practice Address - Zip Code:63664-1937
Practice Address - Country:US
Practice Address - Phone:573-438-3736
Practice Address - Fax:573-436-9200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1799-330320900000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Not Answered385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO85140106Medicaid