Provider Demographics
NPI:1699814335
Name:ADAIR COUNTY R1
Entity Type:Organization
Organization Name:ADAIR COUNTY R1
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SPECIAL EDUCATION
Authorized Official - Prefix:MRS
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:JH
Authorized Official - Last Name:CHARLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-488-6412
Mailing Address - Street 1:600 ROMBAUER AVE
Mailing Address - Street 2:
Mailing Address - City:NOVINGER
Mailing Address - State:MO
Mailing Address - Zip Code:63559-2477
Mailing Address - Country:US
Mailing Address - Phone:660-488-6411
Mailing Address - Fax:660-488-5400
Practice Address - Street 1:600 ROMBAUER AVE
Practice Address - Street 2:
Practice Address - City:NOVINGER
Practice Address - State:MO
Practice Address - Zip Code:63559-2477
Practice Address - Country:US
Practice Address - Phone:660-488-6411
Practice Address - Fax:660-488-5400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251300000XAgenciesLocal Education Agency (LEA)
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO506073402Medicaid