Provider Demographics
NPI:1104167923
Name:POLK COUNTY SENATE BILL 40
Entity type:Organization
Organization Name:POLK COUNTY SENATE BILL 40
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:POLK COUNTY BOARD CHAIR
Authorized Official - Prefix:
Authorized Official - First Name:ARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-777-3000
Mailing Address - Street 1:PO BOX 944
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:MO
Mailing Address - Zip Code:65613-0944
Mailing Address - Country:US
Mailing Address - Phone:417-777-3000
Mailing Address - Fax:
Practice Address - Street 1:4746 S 131ST RD
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613-2886
Practice Address - Country:US
Practice Address - Phone:417-777-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-04
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management