Provider Demographics
NPI:1396066080
Name:PHELPS COUNTY BOARD FOR DEVELOPMENTAL DISABILITIES
Entity type:Organization
Organization Name:PHELPS COUNTY BOARD FOR DEVELOPMENTAL DISABILITIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROCOBERTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-368-0781
Mailing Address - Street 1:1237 COUNTY ROAD 4110
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MO
Mailing Address - Zip Code:65560-3224
Mailing Address - Country:US
Mailing Address - Phone:573-368-0781
Mailing Address - Fax:
Practice Address - Street 1:1237 COUNTY ROAD 4110
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MO
Practice Address - Zip Code:65560-3224
Practice Address - Country:US
Practice Address - Phone:573-368-0781
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-16
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management