Provider Demographics
NPI:1548790033
Name:MAXMATH TUTORING ONLINE INC MISSOURI BRANCH
Entity Type:Organization
Organization Name:MAXMATH TUTORING ONLINE INC MISSOURI BRANCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:MAXCENE
Authorized Official - Last Name:DECARDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-959-4159
Mailing Address - Street 1:1400 FORUM BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-1938
Mailing Address - Country:US
Mailing Address - Phone:888-959-4159
Mailing Address - Fax:888-959-4173
Practice Address - Street 1:1400 FORUM BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-1938
Practice Address - Country:US
Practice Address - Phone:888-959-4159
Practice Address - Fax:888-959-4173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOX001289815251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MON000705299Medicaid