STATE OF MISSOURI NPI 1598906372

NPI Information

NPI: 1598906372
Provider Name: STATE OF MISSOURI

Doing Business As: SOUTHEAST MISSOURI RESIDENTIAL SERVICES ISL

Classification: Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities - 320900000X
Entity Type: Organization
Address:
2351 KANELL BLVD
POPLAR BLUFF, MO
ZIP 63901
Phone: (573) 840-9374
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STATE OF MISSOURI is a community based residential treatment facility, intellectual and/or developmental disabilities in Poplar Bluff, MO. The provider is a home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. STATE OF MISSOURI NPI is 1598906372. The provider is registered as an organization entity type.
The provider Is Doing Business As Southeast Missouri Residential Services Isl.

The provider's business location address is:

2351 KANELL BLVD
POPLAR BLUFF, MO
ZIP 63901-035
Phone: (573) 840-9374

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 3/9/2009 and was last updated on 9/3/2020.

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 Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	320900000X	Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities				Yes

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: 11/14/2023

NPI Synchronization or Removal

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