Provider Type Icon

STATE OF MISSOURI NPI 1013096544


NPI Information

NPI: 1013096544
Provider Name: STATE OF MISSOURI

Doing Business As: COTTONWOOD RESIDENTIAL TREATMENT CENTER

Classification: Psychiatric Residential Treatment Facility - 323P00000X
Entity Type: Organization

CLIA Number: 26D1085716

Address:
1025 N SPRIGG ST
CAPE GIRARDEAU, MO
ZIP 63701
Phone: (573) 290-5888
Get Directions

STATE OF MISSOURI is a psychiatric residential treatment facility in Cape Girardeau, MO. The provider is a residential treatment facility (RTF) is a facility or distinct part of a facility that provides to children and adolescents, a total, twenty-four hour, therapeutically planned group living and learning situation where distinct and individualized psychotherapeutic interventions can take place. Residential treatment is a specific level of care to be differentiated from acute, intermediate, and long-term hospital care, when the least restrictive environment is maintained to allow for normalization of the patient's surroundings. The RTF must be both physically and programmatically distinct if it is a part or subunit of a larger treatment program. An RTF is organized and professionally staffed to provide residential treatment of mental disorders to children and adolescents who have sufficient intellectual potential to respond to active treatment (that is, for whom it can reasonably be assumed that treatment of the mental disorder will result in an improved ability to function outside the RTF) for whom outpatient treatment, partial hospitalization or protected and structured environment is medically or psychologically necessary STATE OF MISSOURI NPI is 1013096544. The provider is registered as an organization entity type.
The provider Is Doing Business As Cottonwood Residential Treatment Center.

The provider's business location address is:

1025 N SPRIGG ST
CAPE GIRARDEAU, MO
ZIP 63701-831
Phone: (573) 290-5888
Fax: (573) 290-5895

The provider's authorized official is Molly Jane Boeckmann .
The authorized official title is Director Of Adminstrative Services and has the following contact phone number (573) 751-4055.

The CLIA number assigned to this NPI record is 26D1085716 - other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/3/2006 and was last updated on 8/28/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1323P00000XPsychiatric Residential Treatment FacilityEXEMPTMISSOURIYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1053445003MEDICAIDMISSOURI
2873445001MEDICAIDMISSOURI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.