Provider Demographics
NPI:1609110642
Name:CHRISTIAN COUNTY BOARD FOR THE DEVELOPMENTALLY DISABLED
Entity Type:Organization
Organization Name:CHRISTIAN COUNTY BOARD FOR THE DEVELOPMENTALLY DISABLED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SWOPE
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:417-839-4336
Mailing Address - Street 1:728 N 22ND ST
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65721-8662
Mailing Address - Country:US
Mailing Address - Phone:417-551-4901
Mailing Address - Fax:417-551-4902
Practice Address - Street 1:728 N 22ND ST
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:MO
Practice Address - Zip Code:65721-8662
Practice Address - Country:US
Practice Address - Phone:417-551-4901
Practice Address - Fax:417-551-4902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management