State of Missouri

NPI #1811137516 in Nevada, Missouri

Provider Information

NPI Number: 1811137516
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: Feb 20, 2009
Last Updated: Aug 28, 2020

Practice Location

Address: 2323 N ASH ST
City: Nevada
State: Missouri
ZIP Code: 64772-1054
Phone: (417) 667-7833

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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