Southeast Missouri Residential Services

NPI #1568601482 in Poplar Bluff, Missouri

Provider Information

NPI Number: 1568601482
Entity Type: Organization
Organization Name: Southeast Missouri Residential Services
Primary Specialty: Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Enumeration Date: Feb 17, 2009
Last Updated: Oct 15, 2020

Practice Location

Address: 2351 KANELL BLVD
City: Poplar Bluff
State: Missouri
ZIP Code: 63901-4035
Phone: (573) 840-9300

Authorized Official

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

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities	320900000X	Primary

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