Provider Demographics
NPI:1679727507
Name:COLE COUNTY RESIDENTIAL SERVICES, INC
Entity Type:Organization
Organization Name:COLE COUNTY RESIDENTIAL SERVICES, INC
Other - Org Name:DAY PROGRAM
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:CASEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-634-4555
Mailing Address - Street 1:1908 BOGGS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65101-5580
Mailing Address - Country:US
Mailing Address - Phone:573-634-4555
Mailing Address - Fax:573-634-4352
Practice Address - Street 1:601 E HIGH ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65101-3218
Practice Address - Country:US
Practice Address - Phone:573-634-4555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLE COUNTY RESIDENTIAL SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-05
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services