SOUTHEAST MISSOURI STATE UNIVERSITY AUTISM CENTER NPI 1699020503

NPI Information

SOUTHEAST MISSOURI STATE UNIVERSITY AUTISM CENTER is a community based residential treatment facility, intellectual and/or developmental disabilities in Cape Girardeau, 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. SOUTHEAST MISSOURI STATE UNIVERSITY AUTISM CENTER NPI is 1699020503. The provider is registered as an organization entity type.

The provider's business location address is:

611 N FOUNTAIN ST
CAPE GIRARDEAU, MO
ZIP 63701-244
Phone: (573) 986-4985
Fax: (573) 986-4994

The provider's authorized official is Connie L Hebert .
The authorized official title is Director and has the following contact phone number (573) 986-4985.

The CLIA number assigned to this NPI record is 26D2290389 - hospital with a certificate type of Certificate of Accreditation.

The enumeration date for this NPI number is 7/17/2012 and was last updated on 7/17/2012.

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:

Other Identifiers

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

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