Provider Demographics
NPI:1750415733
Name:MILLER COUNTY BOARD FOR SERVICES FOR THE DEVELOPMENTALLY DISABLED
Entity type:Organization
Organization Name:MILLER COUNTY BOARD FOR SERVICES FOR THE DEVELOPMENTALLY DISABLED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SPECIAL SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:YEARY
Authorized Official - Last Name:LENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-348-3751
Mailing Address - Street 1:3771 HIGHWAY D
Mailing Address - Street 2:
Mailing Address - City:LAKE OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65049-2290
Mailing Address - Country:US
Mailing Address - Phone:573-348-3751
Mailing Address - Fax:573-348-4065
Practice Address - Street 1:3771 HIGHWAY D
Practice Address - Street 2:
Practice Address - City:LAKE OZARK
Practice Address - State:MO
Practice Address - Zip Code:65049-2290
Practice Address - Country:US
Practice Address - Phone:573-348-3751
Practice Address - Fax:573-348-4065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1881728640Medicaid
MO1790819779Medicaid