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Organization

THOMAS G. MOULDING OR DIXIE MOULDING

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. DIXIE LYNN MOULDING (DIRECTOR)
(785) 454-3473
Entity
Organization

Contact information

Practice address
1112 INGALLS ST, DOWNS, KS 67437-1814
(785) 454-3473
Mailing address
1112 INGALLS ST, DOWNS, KS 67437-1814
(785) 454-3473

Taxonomy

Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00101130237
KS
01
717136138
AMERIGROUP
KS
Enumeration date
03/06/2014
Last updated
03/11/2014
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