1689798456 NPI number — DEVELOPMENTAL DISABILITIES ASSISTANCE BOARD OF MONTGOMERY COUNTY

Table of content: (NPI 1689798456)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689798456 NPI number — DEVELOPMENTAL DISABILITIES ASSISTANCE BOARD OF MONTGOMERY COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEVELOPMENTAL DISABILITIES ASSISTANCE BOARD OF MONTGOMERY COUNTY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689798456
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
230 E NORMAN ST
Provider Second Line Business Mailing Address:
P.O. BOX 63
Provider Business Mailing Address City Name:
MONTGOMERY CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63361-1427
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-564-5045
Provider Business Mailing Address Fax Number:
573-564-3662

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
513 KAY LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTGOMERY CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63361-2311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-564-2778
Provider Business Practice Location Address Fax Number:
573-564-3662
Provider Enumeration Date:
03/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
COLE
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
W.
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
573-564-5045

Provider Taxonomy Codes

  • Taxonomy code: 320900000X , with the licence number:  7070268 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 332B00000X , with the licence number: 7070268 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)





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