Provider Demographics
NPI:1063717684
Name:CAPE COUNTY BOARD FORDEVELOPMENTAL DISABILITIES
Entity type:Organization
Organization Name:CAPE COUNTY BOARD FORDEVELOPMENTAL DISABILITIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:DALE
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:573-450-3494
Mailing Address - Street 1:POST OFFICE BOX 788
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MO
Mailing Address - Zip Code:63755
Mailing Address - Country:US
Mailing Address - Phone:573-450-3494
Mailing Address - Fax:
Practice Address - Street 1:1011 OAK RIDGE CT
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-1711
Practice Address - Country:US
Practice Address - Phone:573-450-3494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-12
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management