Provider Demographics
NPI:1922302595
Name:LINN COUNTY SENATE BILL 40 BOARD
Entity Type:Organization
Organization Name:LINN COUNTY SENATE BILL 40 BOARD
Other - Org Name:LINN COUNTY SENATE BILL 40
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROJAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-258-2877
Mailing Address - Street 1:102 FAIRGROUND RD
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:64628-2070
Mailing Address - Country:US
Mailing Address - Phone:660-258-2877
Mailing Address - Fax:660-258-2886
Practice Address - Street 1:102 FAIRGROUND RD
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:MO
Practice Address - Zip Code:64628-2070
Practice Address - Country:US
Practice Address - Phone:660-258-2877
Practice Address - Fax:660-258-2886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-22
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO858176100Medicaid