Provider Demographics
NPI:1639503691
Name:PROVERB ACADEMY, INC
Entity Type:Organization
Organization Name:PROVERB ACADEMY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ELDRIGE
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:WORLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-614-4318
Mailing Address - Street 1:PO BOX 938
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:MO
Mailing Address - Zip Code:63841-0938
Mailing Address - Country:US
Mailing Address - Phone:573-614-4318
Mailing Address - Fax:573-614-4429
Practice Address - Street 1:420 CARROLL ST
Practice Address - Street 2:
Practice Address - City:MOREHOUSE
Practice Address - State:MO
Practice Address - Zip Code:63868
Practice Address - Country:US
Practice Address - Phone:573-667-0063
Practice Address - Fax:573-614-4429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-27
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002422631322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children