Provider Demographics
NPI:1912227885
Name:MADISON COUNTY ADULT LEARNING CENTER
Entity type:Organization
Organization Name:MADISON COUNTY ADULT LEARNING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TABATHA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-783-3770
Mailing Address - Street 1:610 S CHAMBER DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:63645-1742
Mailing Address - Country:US
Mailing Address - Phone:573-783-3770
Mailing Address - Fax:573-783-5051
Practice Address - Street 1:610 S CHAMBER DR
Practice Address - Street 2:
Practice Address - City:FREDERICKTOWN
Practice Address - State:MO
Practice Address - Zip Code:63645-1742
Practice Address - Country:US
Practice Address - Phone:573-783-3770
Practice Address - Fax:573-783-5051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-02
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services