Provider Demographics
NPI:1558558429
Name:DANIELS FAMILY HOME
Entity Type:Organization
Organization Name:DANIELS FAMILY HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARYANN
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-438-5704
Mailing Address - Street 1:25117 TIMBERLAKE DRIVE
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:MO
Mailing Address - Zip Code:65355-5488
Mailing Address - Country:US
Mailing Address - Phone:660-438-5704
Mailing Address - Fax:
Practice Address - Street 1:24215 HIGHWAY Y
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MO
Practice Address - Zip Code:64439-9114
Practice Address - Country:US
Practice Address - Phone:660-438-5704
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities