Provider Demographics
NPI:1942324041
Name:JASPER COUNTY SHETLERED FACILITIES ASSOC
Entity Type:Organization
Organization Name:JASPER COUNTY SHETLERED FACILITIES ASSOC
Other - Org Name:COMMUNITY SUPPORT SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JHAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:HURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-624-4515
Mailing Address - Street 1:2147 FOREST DR
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:MO
Mailing Address - Zip Code:64836-3673
Mailing Address - Country:US
Mailing Address - Phone:417-358-3833
Mailing Address - Fax:
Practice Address - Street 1:2147 FOREST DR
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MO
Practice Address - Zip Code:64836-3673
Practice Address - Country:US
Practice Address - Phone:417-358-3833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities