Provider Demographics
NPI:1487708459
Name:LIVINGSTON COUNTY DEVELOPMENT CENTER
Entity type:Organization
Organization Name:LIVINGSTON COUNTY DEVELOPMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:QMRP
Authorized Official - Phone:660-646-4374
Mailing Address - Street 1:920 CLINEFELTER ST
Mailing Address - Street 2:P.O.BOX 161
Mailing Address - City:CHILLICOTHE
Mailing Address - State:MO
Mailing Address - Zip Code:64601-2348
Mailing Address - Country:US
Mailing Address - Phone:660-646-4377
Mailing Address - Fax:660-646-3771
Practice Address - Street 1:920 CLINEFELTER ST
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:MO
Practice Address - Zip Code:64601-2348
Practice Address - Country:US
Practice Address - Phone:660-646-4377
Practice Address - Fax:660-646-3771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1631-8495251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services