Provider Demographics
NPI:1104957943
Name:CAMERON CHILDREN'S DEVLEOPMENT CENTER
Entity type:Organization
Organization Name:CAMERON CHILDREN'S DEVLEOPMENT CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-632-7034
Mailing Address - Street 1:PO BOX 81
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:MO
Mailing Address - Zip Code:64429-0081
Mailing Address - Country:US
Mailing Address - Phone:816-632-7034
Mailing Address - Fax:816-632-6507
Practice Address - Street 1:202 W 2ND ST
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:MO
Practice Address - Zip Code:64429-1665
Practice Address - Country:US
Practice Address - Phone:816-632-7034
Practice Address - Fax:816-632-6507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO15589757251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services