Provider Demographics
NPI:1598142069
Name:CLINTON COUNTY SENATE BILL 40 BOARD
Entity Type:Organization
Organization Name:CLINTON COUNTY SENATE BILL 40 BOARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF THE BOARD
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:NONE
Authorized Official - Last Name:GRAYSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-585-7411
Mailing Address - Street 1:PO BOX 397
Mailing Address - Street 2:
Mailing Address - City:LATHROP
Mailing Address - State:MO
Mailing Address - Zip Code:64465-0397
Mailing Address - Country:US
Mailing Address - Phone:816-528-3846
Mailing Address - Fax:
Practice Address - Street 1:406 ELM ST
Practice Address - Street 2:
Practice Address - City:LATHROP
Practice Address - State:MO
Practice Address - Zip Code:64465
Practice Address - Country:US
Practice Address - Phone:816-528-3846
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-04
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities