State of Missouri

NPI #1598844029 in Sikeston, Missouri

Provider Information

NPI Number
1598844029
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 3, 2006
Last Updated
Oct 27, 2020

Practice Location

Address
112 PLAZA DR
ZIP Code
63801-5137
Phone
(573) 472-5300

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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