Provider Demographics
NPI:1700906872
Name:SCATTERED OAKS INC.
Entity type:Organization
Organization Name:SCATTERED OAKS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:WIEMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-265-7422
Mailing Address - Street 1:13045 COUNTY ROAD 2340
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:MO
Mailing Address - Zip Code:65559-7320
Mailing Address - Country:US
Mailing Address - Phone:573-265-7422
Mailing Address - Fax:573-265-8872
Practice Address - Street 1:13045 COUNTY ROAD 2340
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:MO
Practice Address - Zip Code:65559-7320
Practice Address - Country:US
Practice Address - Phone:573-265-7422
Practice Address - Fax:573-265-8872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Not Answered385H00000XRespite Care FacilityRespite Care