Organization
SEMO ALLIANCE FOR DISABILITY INDEPENDENCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARYANN GUDERMUTH (EXECUTIVE DIRECTOR)
(573) 651-6464
Entity
Organization
Contact information
Practice address
1913 RUSMAR ST, CAPE GIRARDEAU, MO 63703-7623
(573) 651-6464
(573) 651-6565
Mailing address
1913 RUSMAR ST, CAPE GIRARDEAU, MO 63703-7623
(573) 651-6464
(573) 651-6565
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1760576425
—
MO
05
—
1932231651
—
MO
Enumeration date
09/25/2014
Last updated
09/25/2014
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