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525 County Road 816 Black MO 63625-9115 | |
(573) 269-4291 | |
(573) 269-4202 |
Full Name | |
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Speciality | Residential Treatment Facility, Emotionally Disturbed Children |
Location | 525 County Road 816, Black, Missouri |
Authorized Official Name and Position | Nicholas Ryan Mayes (GENERAL MANAGER) |
Authorized Official Contact | 5732694291 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Rr 1 Box 127 Black MO 63625-9704 Ph: (573) 269-4291 | 525 County Road 816 Black MO 63625-9115 Ph: (573) 269-4291 |
NPI Number | 1952424566 |
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Provider Enumeration Date | 04/09/2007 |
Last Update Date | 09/23/2022 |
Certification Date | 09/23/2022 |
Identifier | Type | State | Issuer |
---|---|---|---|
1952424566 | NPI | - | NPPES |
489582863 | Medicaid | MO |
Valley Springs Youth Ranch Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 525 County Road 816, Black, MO 63625 Phone: 573-269-4291 Fax: 573-269-4202 |