Provider Demographics
NPI:1679793053
Name:WASHINGTON COUNTY HANDICAPPED SERVICES IN HOME PERSONAL CARE SERVICES
Entity type:Organization
Organization Name:WASHINGTON COUNTY HANDICAPPED SERVICES IN HOME PERSONAL CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:PERRY
Authorized Official - Last Name:HAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-438-2864
Mailing Address - Street 1:10604 WEST HIGHWAY E
Mailing Address - Street 2:
Mailing Address - City:POTOSI
Mailing Address - State:MO
Mailing Address - Zip Code:63664
Mailing Address - Country:US
Mailing Address - Phone:573-438-2864
Mailing Address - Fax:573-438-4529
Practice Address - Street 1:10604 WEST HIGHWAY E
Practice Address - Street 2:
Practice Address - City:POTOSI
Practice Address - State:MO
Practice Address - Zip Code:63664-0000
Practice Address - Country:US
Practice Address - Phone:573-438-2864
Practice Address - Fax:573-438-4529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0008959OtherSSBGGR