Provider Demographics
NPI:1700150927
Name:RIPLEY COUNTY FAMILY RESOURCE CENTER
Entity Type:Organization
Organization Name:RIPLEY COUNTY FAMILY RESOURCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:SILMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:573-996-2648
Mailing Address - Street 1:204 SUMMIT
Mailing Address - Street 2:
Mailing Address - City:DONIPHAN
Mailing Address - State:MO
Mailing Address - Zip Code:63935
Mailing Address - Country:US
Mailing Address - Phone:573-996-2648
Mailing Address - Fax:573-996-2649
Practice Address - Street 1:204 SUMMIT ST.,
Practice Address - Street 2:
Practice Address - City:DONIPHAN
Practice Address - State:MO
Practice Address - Zip Code:63935
Practice Address - Country:US
Practice Address - Phone:573-996-2648
Practice Address - Fax:573-996-2649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-06
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003016881251S00000X
MO002180251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO129505960Medicaid