Organization
HANNIBAL COUNCIL ON ALCOHOL & DRUG ABUSE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER JO WILSON (EXECUTIVE DIRECTOR)
(573) 248-1196
Entity
Organization
Contact information
Practice address
146 COMMUNICATION DRIVE, HANNIBAL, MO 63401
(573) 248-1196
(573) 231-0982
Mailing address
146 COMMUNICATION DRIVE, HANNIBAL, MO 63401
(573) 248-1196
(573) 231-0982
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8001749
DMH VENDOR NUMBER
MO
05
—
866203102
—
MO
Enumeration date
03/13/2007
Last updated
05/29/2013
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