Provider Demographics
NPI:1487778155
Name:JASPER COUNTY SHELTERED FACILITIES ASSOC
Entity type:Organization
Organization Name:JASPER COUNTY SHELTERED FACILITIES ASSOC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JHAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:HURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-624-4515
Mailing Address - Street 1:706 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:CARL JUNCTION
Mailing Address - State:MO
Mailing Address - Zip Code:64801
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2312 ANNIE BAXTER AVE
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-0329
Practice Address - Country:US
Practice Address - Phone:417-624-4515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities