Organization
ICAN MISSOURI FOUNDATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES L. O'LOUGHLIN (BOARD MEMBER)
(660) 269-4549
Entity
Organization
Contact information
Practice address
105 NORTH AVE, MOBERLY, MO 65270-2860
(660) 269-8875
Mailing address
2000 S HIGHWAY 63, PO BOX 280, MOBERLY, MO 65270-4532
(660) 269-4549
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Enumeration date
07/25/2016
Last updated
07/25/2016
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