State of Missouri
NPI #1760553101 in Saint Louis, Missouri
Provider Information
- NPI Number
- 1760553101
- 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 20, 2020
Practice Location
- Address
- 10695 BELLEFONTAINE RD
- City
- Saint Louis
- State
- Missouri
- ZIP Code
- 63137-2315
- Phone
- (314) 340-6000
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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