MAPLE CREST RESIDENTIAL CARE FACILITY NPI 1619147428

NPI Information

  • NPI: 1619147428
  • Provider Name: MAPLE CREST RESIDENTIAL CARE FACILITY
  • Classification: Community Based Residential Treatment Facility, Mental Illness - 320800000X
  • Entity Type: Organization
  • Address: 307 N BROADWAY ST
    POPLAR BLUFF, MO
    ZIP 63901
  • Phone: (573) 686-4490

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NPI Details

MAPLE CREST RESIDENTIAL CARE FACILITY is a community based residential treatment facility mental illness in Poplar Bluff, MO. The provider is a home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. MAPLE CREST RESIDENTIAL CARE FACILITY NPI is 1619147428. The provider is registered as an organization entity type.

The provider's business location address is:

307 N BROADWAY ST
POPLAR BLUFF, MO
ZIP 63901-103
Phone: (573) 686-4490
Fax: (573) 686-8817

The provider's authorized official is Mark Allen Keeney .
The authorized official title is Owner and has the following contact phone number (573) 686-4490.

The enumeration date for this NPI number is 3/7/2008 and was last updated on 3/7/2008.

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
1320800000XCommunity Based Residential Treatment Facility, Mental IllnessMISSOURIYes

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: 11/21/2025

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