State of Missouri
NPI #1124198981 in Poplar Bluff, Missouri
Provider Information
- NPI Number
- 1124198981
- Entity Type
- Organization
- Organization Name
- State of Missouri
- Subpart
- Yes (part of a larger organization)
- Parent Organization
- STATE OF MISSOURI
- Primary Specialty
- Intermediate Care Facility, Intellectual Disabilities
- Enumeration Date
- Nov 9, 2006
- Last Updated
- Oct 27, 2020
Practice Location
- Address
- 2351 KANELL BLVD
- City
- Poplar Bluff
- State
- Missouri
- ZIP Code
- 63901-4035
- Phone
- (573) 840-9370
Authorized Official
- Name
- MOLLY JANE BOECKMANN
- Title
- DIRECTOR OF ADMINISTRATIVE SERVICES
- Phone
- (573) 751-4055
Specialties & Taxonomy Codes
| Specialty |
|---|
| Intermediate Care Facility, Intellectual Disabilities |
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