# NORTHWEST MISSOURI SUPPORTIVE SERVICES

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093844722
- **Authorized official:** MARTIN DALE WEATHERD (EXECUTIVE MANAGER)
- **Authorized official phone:** (816) 827-1254

## Contact information

- **Practice address:** 308 SOUTH PROSPECT, STANBERRY, MO 64489-0222
- **Practice address phone:** (660) 783-2464
- **Mailing address:** PO BOX 222, 401 SOUTH STANBERRY STREET, STANBERRY, MO 64489-0222
- **Mailing address phone:** (660) 783-2842

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 03/06/2007
- **Last updated:** 08/22/2020