Provider Demographics
NPI:1942423678
Name:ARBORVALE
Entity type:Organization
Organization Name:ARBORVALE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIDEOUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-996-3203
Mailing Address - Street 1:HC 6 BOX 21
Mailing Address - Street 2:
Mailing Address - City:DONIPHAN
Mailing Address - State:MO
Mailing Address - Zip Code:63935-9001
Mailing Address - Country:US
Mailing Address - Phone:573-996-3203
Mailing Address - Fax:
Practice Address - Street 1:HC 6 BOX 21
Practice Address - Street 2:
Practice Address - City:DONIPHAN
Practice Address - State:MO
Practice Address - Zip Code:63935-9001
Practice Address - Country:US
Practice Address - Phone:573-996-3203
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Not Answered385H00000XRespite Care FacilityRespite Care