Provider Demographics
NPI:1013323807
Name:DAVIESS COUNTY BOARD FOR THE DEVELOPMENTALLY DISABLED
Entity type:Organization
Organization Name:DAVIESS COUNTY BOARD FOR THE DEVELOPMENTALLY DISABLED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:
Authorized Official - Last Name:CRITTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-663-7019
Mailing Address - Street 1:109 E JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:MO
Mailing Address - Zip Code:64640-1147
Mailing Address - Country:US
Mailing Address - Phone:660-663-2050
Mailing Address - Fax:660-663-2060
Practice Address - Street 1:109 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:MO
Practice Address - Zip Code:64640-1147
Practice Address - Country:US
Practice Address - Phone:660-663-2050
Practice Address - Fax:660-663-2060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-01
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management