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Active NPI 1982978169 Organization (Entity Type 2)

Randolph County Developmental Disability Services

Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities • Moberly, MO

About Randolph County Developmental Disability Services NPI 1982978169 Summary

Randolph County Developmental Disability Services is a verified healthcare organization specializing in Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities operating in Moberly, MO. Located at 101 W COATES ST, this facility provides patient care and medical services under National Provider Identifier (NPI) 1982978169.

Administrative operations and authorized compliance are overseen by Mindy Breid (Director Of Administration).

The facility is associated with 2 linked healthcare practitioners providing clinical services.

Facility Location & Contact Primary Location

Facility Address

101 W Coates St

Moberly, MO 652701521

Telephone 6602698875

Fax 6602699621

Authorized Official Information

Authorized Contact Name

MRS. Mindy Breid

Title / Role

Director Of Administration

Official Telephone

6602698875

Facility Classifications & Specialties

Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities Primary Taxonomy

NUCC Taxonomy Code: 320900000X

A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with intellectual and/or developmental disabilities.

Affiliated Practitioners & Clinicians

Healthcare professionals and specialists practicing at this facility or affiliated group locations

2 Linked

Finess Copeland NPI 1043015514

Registered Nurse

Moberly, MO

View Practitioner Profile →

Tiffany Lopez , CPS NPI 1770418907

Peer Specialist

Moberly, MO

View Practitioner Profile →

Facility & Registry History Timeline

Chronological log of verified NPI organization updates, branch relocations, and registry updates

6 Historical Events

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NPI Profile Active September 04, 2012

NPI status registered as active in NPPES database

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Updated Practice Location September 04, 2012

Registered at 101 W COATES ST, MOBERLY, MO 652701521 (Tel: 6602698875)

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Updated Business Mailing Address September 04, 2012

Registered at PO BOX 1008, MOBERLY, MO 652700975 (Tel: 6602698875)

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Organization / Clinic Name Updated September 04, 2012

Operating as RANDOLPH COUNTY DEVELOPMENTAL DISABILITY SERVICES

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Medical Taxonomy / Specialty Registered (Primary Specialty) September 04, 2012

Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities

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Initial NPI Registration & Enumeration March 06, 2012

First registered as active Healthcare Organization in NPPES Database.

Patient & Community Reviews

Verified patient ratings, healthcare experiences, and facility photos

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NPI Organization Metadata

NPI Number: 1982978169

Entity Type:

Organization Organization (Hospital, Clinic, Group Practice) (Type 2 NPI)

Enumeration Date: March 06, 2012

Last Update: September 04, 2012

Update or Correct Listing

Mailing Address

Po Box 1008

Moberly, MO 652700975

Phone: 6602698875

Public Domain Record This organization profile is sourced from public domain datasets published by CMS and NPPES under FOIA.

⚠️ Medical Disclaimer

Facility details are provided for public information only. In case of a medical emergency, call 911 immediately.