Provider Demographics
NPI:1396941381
Name:DENT COUNTY DEVELOPMENTAL DISABILITIES BOARD
Entity type:Organization
Organization Name:DENT COUNTY DEVELOPMENTAL DISABILITIES BOARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:F
Authorized Official - Last Name:HOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-729-4738
Mailing Address - Street 1:PO BOX 702
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MO
Mailing Address - Zip Code:65560-0702
Mailing Address - Country:US
Mailing Address - Phone:573-729-4738
Mailing Address - Fax:
Practice Address - Street 1:1900 S. MAIN ST.
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MO
Practice Address - Zip Code:65560
Practice Address - Country:US
Practice Address - Phone:573-729-4738
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management