Provider Demographics
NPI:1841327061
Name:WEST CENTRAL MO CAA
Entity type:Organization
Organization Name:WEST CENTRAL MO CAA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:AMOS
Authorized Official - Middle Name:E
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-476-2185
Mailing Address - Street 1:PO BOX 125
Mailing Address - Street 2:110 W. 4TH STREET
Mailing Address - City:APPLETON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64724-0125
Mailing Address - Country:US
Mailing Address - Phone:660-476-2185
Mailing Address - Fax:660-476-2609
Practice Address - Street 1:106 W 4TH ST
Practice Address - Street 2:
Practice Address - City:APPLETON CITY
Practice Address - State:MO
Practice Address - Zip Code:64724-1402
Practice Address - Country:US
Practice Address - Phone:660-476-2185
Practice Address - Fax:660-476-2609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO070058Medicaid
MO29823019PIN 29824017Medicaid