Provider Demographics
NPI:1689851339
Name:DISABLED CITIZENS ALLIANCE FOR INDEPENDENCE
Entity Type:Organization
Organization Name:DISABLED CITIZENS ALLIANCE FOR INDEPENDENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PAYROLL COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:TAMMIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-244-5705
Mailing Address - Street 1:8 MISSOURI AVE
Mailing Address - Street 2:PO BOX 675
Mailing Address - City:VIBURNUM
Mailing Address - State:MO
Mailing Address - Zip Code:65566-8633
Mailing Address - Country:US
Mailing Address - Phone:573-244-5705
Mailing Address - Fax:573-244-5880
Practice Address - Street 1:8 MISSOURI AVE
Practice Address - Street 2:
Practice Address - City:VIBURNUM
Practice Address - State:MO
Practice Address - Zip Code:65566-8633
Practice Address - Country:US
Practice Address - Phone:573-244-5705
Practice Address - Fax:573-244-5880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-24
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO286247705Medicaid