Provider Demographics
NPI:1760576425
Name:SEMO ALLIANCE FOR DISABILITY INDEPENDENCE, INC.
Entity Type:Organization
Organization Name:SEMO ALLIANCE FOR DISABILITY INDEPENDENCE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DRIECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARYANN
Authorized Official - Middle Name:
Authorized Official - Last Name:GUDERMUTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-651-6464
Mailing Address - Street 1:121 S BROADVIEW ST STE 12
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-5702
Mailing Address - Country:US
Mailing Address - Phone:573-651-6464
Mailing Address - Fax:573-651-6565
Practice Address - Street 1:121 S BROADVIEW ST STE 12
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-5702
Practice Address - Country:US
Practice Address - Phone:573-651-6464
Practice Address - Fax:573-651-6565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Single Specialty
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO266211804Medicaid