Provider Demographics
NPI:1669591392
Name:SHANNON'S NEIGHBORHOOD MAINSTREET INC.
Entity type:Organization
Organization Name:SHANNON'S NEIGHBORHOOD MAINSTREET INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:S
Authorized Official - Last Name:ZAHNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-547-4226
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 LANE
Practice Address - Street 2:
Practice Address - City:PERRYVILLE
Practice Address - State:MO
Practice Address - Zip Code:63775
Practice Address - Country:US
Practice Address - Phone:573-547-4226
Practice Address - Fax:573-547-4226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO665251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services