State of Missouri
NPI #1760681415 in Independence, Missouri
Provider Information
- NPI Number
- 1760681415
- 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
- Jul 13, 2007
- Last Updated
- Oct 20, 2020
Practice Location
- Address
- 1501 N RIVER BLVD
- City
- Independence
- State
- Missouri
- ZIP Code
- 64050-1760
- Phone
- (816) 512-7515
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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