Provider Demographics
NPI:1003930520
Name:SPECIALTY PRODUCTS & SERVICES, INC.
Entity type:Organization
Organization Name:SPECIALTY PRODUCTS & SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:CHASTITY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:COURTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-624-9925
Mailing Address - Street 1:402 S WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:MO
Mailing Address - Zip Code:63841-2146
Mailing Address - Country:US
Mailing Address - Phone:573-624-9925
Mailing Address - Fax:573-624-9928
Practice Address - Street 1:402 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:MO
Practice Address - Zip Code:63841-2146
Practice Address - Country:US
Practice Address - Phone:573-624-9925
Practice Address - Fax:573-624-9928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO857834204Medicaid