Provider Demographics
NPI:1306508593
Name:LACEY ANN SKELTON
Entity type:Organization
Organization Name:LACEY ANN SKELTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LACEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SKELTON
Authorized Official - Suffix:
Authorized Official - Credentials:LEVEL 1 MED AIDE
Authorized Official - Phone:573-226-5426
Mailing Address - Street 1:18941 CR 305A
Mailing Address - Street 2:
Mailing Address - City:EMINENCE
Mailing Address - State:MO
Mailing Address - Zip Code:65466-6268
Mailing Address - Country:US
Mailing Address - Phone:573-226-5426
Mailing Address - Fax:573-226-5426
Practice Address - Street 1:18941 CR 305A
Practice Address - Street 2:
Practice Address - City:EMINENCE
Practice Address - State:MO
Practice Address - Zip Code:65466-6268
Practice Address - Country:US
Practice Address - Phone:573-226-5426
Practice Address - Fax:573-226-5426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-06
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities