Provider Demographics
NPI:1750405247
Name:HENRY COUNTY R-I
Entity type:Organization
Organization Name:HENRY COUNTY R-I
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:ELSENSOHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-647-3533
Mailing Address - Street 1:210 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:MO
Mailing Address - Zip Code:65360-1247
Mailing Address - Country:US
Mailing Address - Phone:660-647-3533
Mailing Address - Fax:660-647-3218
Practice Address - Street 1:210 NORTH ST
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:MO
Practice Address - Zip Code:65360-1247
Practice Address - Country:US
Practice Address - Phone:660-647-3533
Practice Address - Fax:660-647-3218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO476087507Medicaid
MO486087505Medicaid
MO466087509Medicaid