Provider Demographics
NPI:1992028112
Name:HILDA FUWELL'S RESIDENTIAL CARE LLC
Entity Type:Organization
Organization Name:HILDA FUWELL'S RESIDENTIAL CARE LLC
Other - Org Name:ADAPTIVE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-568-2056
Mailing Address - Street 1:17382 STATE HIGHWAY 25
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:MO
Mailing Address - Zip Code:63841-9710
Mailing Address - Country:US
Mailing Address - Phone:573-568-2056
Mailing Address - Fax:573-568-2314
Practice Address - Street 1:900 SOUTH ONE MILE ROAD
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:MO
Practice Address - Zip Code:63841
Practice Address - Country:US
Practice Address - Phone:573-614-4191
Practice Address - Fax:573-568-2314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-02
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health