Provider Demographics
NPI:1265885792
Name:SPECIAL NEEDS SERVICES OF RAY COUNTY
Entity type:Organization
Organization Name:SPECIAL NEEDS SERVICES OF RAY COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUZAN
Authorized Official - Middle Name:LORRAINE
Authorized Official - Last Name:BREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-470-5045
Mailing Address - Street 1:810 E MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:MO
Mailing Address - Zip Code:64085
Mailing Address - Country:US
Mailing Address - Phone:816-470-5045
Mailing Address - Fax:816-470-8066
Practice Address - Street 1:810 E MAIN STREET
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:MO
Practice Address - Zip Code:64085
Practice Address - Country:US
Practice Address - Phone:816-470-5045
Practice Address - Fax:816-470-8066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-20
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty