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WOODRIDGE OF MISSOURI INC. NPI 1174662720


NPI Information

NPI: 1174662720
Provider Name: WOODRIDGE OF MISSOURI, INC.

Doing Business As: PINEY RIDGE CENTER

Classification: Residential Treatment Facility, Emotionally Disturbed Children - 322D00000X
Entity Type: Organization

CLIA Number: 26D0923842

Address:
1000 HOSPITAL ROAD
WAYNESVILLE, MO
ZIP 65583
Phone: (573) 774-5353
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WOODRIDGE OF MISSOURI, INC. is a residential treatment facility emotionally disturbed children in Waynesville, MO. The provider is a residential facility that provides habilitation services and other care and treatment to children diagnosed with mental health illness, behavioral issues, and intellectual disabilities and are not able to live independently. WOODRIDGE OF MISSOURI, INC. NPI is 1174662720. The provider is registered as an organization entity type.
The provider Is Doing Business As Piney Ridge Center.

The provider's business location address is:

1000 HOSPITAL ROAD
WAYNESVILLE, MO
ZIP 65583-067
Phone: (573) 774-5353
Fax: (573) 774-2907

The provider's authorized official is Rochelle Gerber .
The authorized official title is Avp Of Administrative Services and has the following contact phone number (470) 554-7903.

The CLIA number assigned to this NPI record is 26D0923842 - other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/6/2007 and was last updated on 11/23/2021.


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 Facility000380592MISSOURINo
2324500000XSubstance Abuse Rehabilitation Facility30888669MISSOURINo
3324500000XSubstance Abuse Rehabilitation Facility3088-11051MISSOURINo
4324500000XSubstance Abuse Rehabilitation Facility000380592MISSOURINo
5322D00000XResidential Treatment Facility, Emotionally Disturbed Children000380592MISSOURIYes

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

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