STATE OF MISSOURI is an intermediate care facility mentally retarded in Saint Louis, MO. The provider is (1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals. STATE OF MISSOURI NPI is 1770866030. The provider is registered as an organization entity type.
The provider Is Doing Business As Bellefontaine Habilitaion Center-waiver Services.
The provider's business location address is:
10695 BELLEFONTAINE RD
SAINT LOUIS, MO
ZIP 63137-315
Phone: (314) 340-6000
Fax: (314) 340-6199
The provider's authorized official is Molly Jane Boeckmann .
The authorized official title is Director Of Administrative Services and has the following contact phone number (573) 751-4055.
The enumeration date for this NPI number is 9/23/2011 and was last updated on 10/27/2020.