Provider Demographics
NPI:1699314732
Name:BOOTHEEL COMMUNITY DEVELOPMENT CORPORATION
Entity type:Organization
Organization Name:BOOTHEEL COMMUNITY DEVELOPMENT CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROJECT MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNEAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-688-2512
Mailing Address - Street 1:6909 US HIGHWAY 61
Mailing Address - Street 2:
Mailing Address - City:NEW MADRID
Mailing Address - State:MO
Mailing Address - Zip Code:63869-9186
Mailing Address - Country:US
Mailing Address - Phone:573-688-2512
Mailing Address - Fax:
Practice Address - Street 1:6909 US HIGHWAY 61
Practice Address - Street 2:
Practice Address - City:NEW MADRID
Practice Address - State:MO
Practice Address - Zip Code:63869-9186
Practice Address - Country:US
Practice Address - Phone:573-688-2512
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-06
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care