Organization
CAMDEN COUNTY SENATE BILL 40 BOARD
Active
Other names
Camden County Developmental Disability Resources
Organization subpart
No
Provider details
NPI number
Authorized official
BOONE CALEB WAGNER (EXECUTIVE DIRECTOR)
(573) 317-9233
Entity
Organization
Contact information
Practice address
100 3RD STREET, CAMDENTON, MO 65020
(573) 317-9233
(573) 317-9332
Mailing address
P.O. BOX 722, CAMDENTON, MO 65020
(573) 317-9233
(573) 317-9332
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
156234809
—
MO
05
—
156248809
—
MO
Enumeration date
01/30/2007
Last updated
10/05/2011
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