Provider Demographics
NPI:1689849143
Name:MANCHESTER CENTER FOR DEVELOPMENTALLY DISABLED
Entity Type:Organization
Organization Name:MANCHESTER CENTER FOR DEVELOPMENTALLY DISABLED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ALYSSA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:CONTINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-391-0251
Mailing Address - Street 1:129 WOODS MILL RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MO
Mailing Address - Zip Code:63011-4339
Mailing Address - Country:US
Mailing Address - Phone:636-391-0251
Mailing Address - Fax:
Practice Address - Street 1:129 WOODS MILL RD
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:MO
Practice Address - Zip Code:63011-4339
Practice Address - Country:US
Practice Address - Phone:636-391-0251
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO12556939261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care