Provider Demographics
NPI:1578687307
Name:CHILDREN'S THERAPY CENTER OF PETTIS COUNTY, INC
Entity Type:Organization
Organization Name:CHILDREN'S THERAPY CENTER OF PETTIS COUNTY, INC
Other - Org Name:CENTER FOR HUMAN SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-826-4400
Mailing Address - Street 1:1500 EWING DR
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301-2396
Mailing Address - Country:US
Mailing Address - Phone:660-826-4400
Mailing Address - Fax:866-495-6424
Practice Address - Street 1:1500 EWING DR
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-2396
Practice Address - Country:US
Practice Address - Phone:660-826-4400
Practice Address - Fax:866-495-6424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO851306407Medicaid