Provider Demographics
NPI:1831424951
Name:NORMILE FAMILY CENTER
Entity type:Organization
Organization Name:NORMILE FAMILY CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:JUVENILE SERVICES ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:D
Authorized Official - Last Name:HOLT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-665-4224
Mailing Address - Street 1:1400 S BOUNDARY ST
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-1704
Mailing Address - Country:US
Mailing Address - Phone:660-665-4224
Mailing Address - Fax:660-665-2968
Practice Address - Street 1:1400 S BOUNDARY ST
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-1704
Practice Address - Country:US
Practice Address - Phone:660-665-4224
Practice Address - Fax:660-665-2968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-07
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO001528243322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children