Organization
DANCING HORIZON HEALTH FOUNDATION, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN W LOUDERBACK HHP CHT PSYD (MANAGING PARTNER)
(417) 429-2180
Entity
Organization
Contact information
Practice address
2400 BOONSLICK DRIVE, BOONVILLE, MO 65233
(660) 882-9840
(660) 882-3504
Mailing address
PO BOX 5111, SPRINGFIELD, MO 65802
(417) 429-2180
(417) 832-9799
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
RIF83
MO
261Q00000X
Clinic/Center
Primary
—
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
202805958
—
MO
05
—
501465009
—
MO
Enumeration date
07/23/2006
Last updated
07/18/2008
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