Provider Demographics
NPI:1629599972
Name:B.J. PRICE, INC.
Entity Type:Organization
Organization Name:B.J. PRICE, INC.
Other - Org Name:R-PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-778-5878
Mailing Address - Street 1:14110 LINDSEY LN
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-9760
Mailing Address - Country:US
Mailing Address - Phone:573-778-5878
Mailing Address - Fax:573-609-2287
Practice Address - Street 1:3439 S WESTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-8670
Practice Address - Country:US
Practice Address - Phone:573-686-1381
Practice Address - Fax:573-609-2287
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:B.J. PRICE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-06-27
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOEC-04920117320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities