Organization
PRC ENTERPRISES
Active
Other names
A1care
Organization subpart
No
Provider details
NPI number
Authorized official
MS. PATRICIA ROSE CAMPBELL (OWNER)
(573) 778-1126
Entity
Organization
Contact information
Practice address
650 VINE ST, POPLAR BLUFF, MO 63901-5039
(573) 778-1126
(573) 785-4887
Mailing address
650 VINE ST, POPLAR BLUFF, MO 63901-5039
(573) 778-1126
(573) 785-4887
Taxonomy
Speciality
Code
Description
License number
State
103TM1800X
Intellectual & Developmental Disabilities Psychologist
Primary
14078480
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
193400000X
—
MO
Enumeration date
12/08/2006
Last updated
06/12/2008
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