Provider Demographics
NPI:1467645119
Name:SHANNON'S NEIGHBORHOOD MAINSTREET STATION
Entity type:Organization
Organization Name:SHANNON'S NEIGHBORHOOD MAINSTREET STATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:ZAHNER
Authorized Official - Suffix:
Authorized Official - Credentials:ADULT DAY HEALTH CAR
Authorized Official - Phone:573-768-5339
Mailing Address - Street 1:10 SHANNON LN
Mailing Address - Street 2:
Mailing Address - City:PERRYVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63775-8169
Mailing Address - Country:US
Mailing Address - Phone:573-547-4226
Mailing Address - Fax:573-547-4226
Practice Address - Street 1:35 SHANNON LN
Practice Address - Street 2:
Practice Address - City:PERRYVILLE
Practice Address - State:MO
Practice Address - Zip Code:63775-8169
Practice Address - Country:US
Practice Address - Phone:573-547-4226
Practice Address - Fax:573-547-4226
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHANNONS NEIGHBORHOOD MAIN STREET STATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care