Provider Demographics
NPI:1336222173
Name:OSAGE COUNTY COMMUNITY LIVING, INC
Entity Type:Organization
Organization Name:OSAGE COUNTY COMMUNITY LIVING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCCUSKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-897-2991
Mailing Address - Street 1:PO BOX 913
Mailing Address - Street 2:1006 EAST JEFFERSON ST
Mailing Address - City:LINN
Mailing Address - State:MO
Mailing Address - Zip Code:65051-0913
Mailing Address - Country:US
Mailing Address - Phone:573-897-2991
Mailing Address - Fax:573-897-4763
Practice Address - Street 1:1006 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:LINN
Practice Address - State:MO
Practice Address - Zip Code:65051-9710
Practice Address - Country:US
Practice Address - Phone:573-897-2991
Practice Address - Fax:573-897-4763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO265433409Medicaid