Provider Demographics
NPI:1689243891
Name:CATHOLIC CHARITIES OF SOUTHERN MISSOURI FOR MISSISSIPPI CO
Entity Type:Organization
Organization Name:CATHOLIC CHARITIES OF SOUTHERN MISSOURI FOR MISSISSIPPI CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:LUNARDINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-720-4213
Mailing Address - Street 1:424 E MONASTERY ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-6099
Mailing Address - Country:US
Mailing Address - Phone:417-507-4139
Mailing Address - Fax:
Practice Address - Street 1:205 W MALONE AVE STE B
Practice Address - Street 2:
Practice Address - City:SIKESTON
Practice Address - State:MO
Practice Address - Zip Code:63801-2826
Practice Address - Country:US
Practice Address - Phone:573-481-0659
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CATHOLIC CHARITIES OF SOUTHERN MISSOURI
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management