Provider Demographics
NPI:1679746382
Name:LAFAYETTE COUNTY BOARD OF SHELTERED SERVICES
Entity Type:Organization
Organization Name:LAFAYETTE COUNTY BOARD OF SHELTERED SERVICES
Other - Org Name:LCBSS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:T
Authorized Official - Last Name:WHITLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-584-3101
Mailing Address - Street 1:312 W 19TH ST
Mailing Address - Street 2:PO BOX 48
Mailing Address - City:HIGGINSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64037-1513
Mailing Address - Country:US
Mailing Address - Phone:660-584-3101
Mailing Address - Fax:660-584-8688
Practice Address - Street 1:312 W 19TH ST
Practice Address - Street 2:
Practice Address - City:HIGGINSVILLE
Practice Address - State:MO
Practice Address - Zip Code:64037-1513
Practice Address - Country:US
Practice Address - Phone:660-584-3101
Practice Address - Fax:660-584-8688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-03
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO6606199Medicaid