State of Missouri

NPI #1528333085 in Nevada, Missouri

Provider Information

NPI Number
1528333085
Entity Type
Organization
Organization Name
State of Missouri
Subpart
Yes (part of a larger organization)
Parent Organization
STATE OF MISSOURI
Primary Specialty
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Enumeration Date
Mar 16, 2012
Last Updated
Aug 28, 2020

Practice Location

Address
1000 N COLORADO ST
City
Nevada
ZIP Code
64772-1618
Phone
(417) 667-7833

Authorized Official

Name
MOLLY JANE BOECKMANN
Title
DIRECTOR OF ADMINISTRATIVE SERVICES
Phone
(573) 751-4055

Specialties & Taxonomy Codes

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

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