Provider Demographics
NPI:1689017378
Name:STODDARD COUNTY TARGETED CASE MANAGEMENT INC
Entity Type:Organization
Organization Name:STODDARD COUNTY TARGETED CASE MANAGEMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MCCLURE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-614-5095
Mailing Address - Street 1:PO BOX 733
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:MO
Mailing Address - Zip Code:63841-0733
Mailing Address - Country:US
Mailing Address - Phone:573-614-5095
Mailing Address - Fax:573-614-5114
Practice Address - Street 1:1203 COUNTY ROAD 431
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:MO
Practice Address - Zip Code:63841-2400
Practice Address - Country:US
Practice Address - Phone:573-614-5095
Practice Address - Fax:573-614-5114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-11
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management