Provider Demographics
NPI:1700061454
Name:SHELBY COUNTY SENIOR CITIZENS ASSOCIATION INC.
Entity Type:Organization
Organization Name:SHELBY COUNTY SENIOR CITIZENS ASSOCIATION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:SPARKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-588-4403
Mailing Address - Street 1:112 EAST CHESTNUT
Mailing Address - Street 2:
Mailing Address - City:SHELBINA
Mailing Address - State:MO
Mailing Address - Zip Code:63468-1339
Mailing Address - Country:US
Mailing Address - Phone:573-588-4403
Mailing Address - Fax:573-588-1406
Practice Address - Street 1:112 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:SHELBINA
Practice Address - State:MO
Practice Address - Zip Code:63468-1339
Practice Address - Country:US
Practice Address - Phone:573-588-4403
Practice Address - Fax:573-588-1406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0000457251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care