Provider Demographics
NPI:1629366182
Name:BLETEL RESIDENTIAL HOMES
Entity type:Organization
Organization Name:BLETEL RESIDENTIAL HOMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLEBOO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-855-4652
Mailing Address - Street 1:P.O. BOX 507
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65583
Mailing Address - Country:US
Mailing Address - Phone:573-774-6166
Mailing Address - Fax:573-774-8548
Practice Address - Street 1:18844 LADERA LN
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:MO
Practice Address - Zip Code:65583
Practice Address - Country:US
Practice Address - Phone:573-774-5348
Practice Address - Fax:573-774-8548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-19
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities