Provider Demographics
NPI:1679637680
Name:RAY COUNTY COMMUNITY SERVICES INC.
Entity Type:Organization
Organization Name:RAY COUNTY COMMUNITY SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:W
Authorized Official - Last Name:LILLARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-776-5904
Mailing Address - Street 1:1202 HIGHWAY 13
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:MO
Mailing Address - Zip Code:64085-2249
Mailing Address - Country:US
Mailing Address - Phone:816-776-5904
Mailing Address - Fax:816-494-5510
Practice Address - Street 1:1202 HIGHWAY 13
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:MO
Practice Address - Zip Code:64085-2249
Practice Address - Country:US
Practice Address - Phone:816-776-5904
Practice Address - Fax:816-494-5510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO8000401251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO8000401OtherPROVIDER NUMBER
MO858166606Medicaid