NPIMap

Organization Active NPI

State of Missouri

  • Psychiatric Residential Treatment Facility
  • Cape Girardeau, MO
National Provider Identifier
1013096544
Registry record updated Aug 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Residential Treatment FacilityTaxonomy code 323P00000X
License
EXEMPT Issued in MO
Legal business name
STATE OF MISSOURI
Practice address
1025 N Sprigg St
Cape Girardeau, MO 63701-4831
Phone
(573) 290-5888
Fax
(573) 290-5895
NPI assigned
Nov 3, 2006
Organization subpart
Yes
Parent organization
STATE OF MISSOURIAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 28, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Molly Jane Boeckmann
Title
Director of Adminstrative Services
Phone
(573) 751-4055

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Residential Treatment Facility 323P00000X EXEMPT MO Primary

Addresses

Primary practice location

1025 N Sprigg St
Cape Girardeau, MO 63701-4831

Mailing address

PO Box 687
Jefferson City, MO 65102-0687
Phone (573) 751-3398

Other identifiers 2

IdentifierTypeStateIssuer
053445003MedicaidMO
873445001MedicaidMO

Other names 1

  • Cottonwood Residential Treatment Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Southwest Missouri Psy104 organizations share this tax ID, including this one
Part of
Southwest Missouri Psy

Organizations with this tax ID in the same state 12

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

Locations

1025 N Sprigg St
Cape Girardeau, MO 63701
Phone (573) 290-5888

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598572800000",
    "number": "1013096544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 687",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651020687",
            "telephone_number": "573-751-3398",
            "fax_number": "573-526-4560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1025 N SPRIGG ST",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "637014831",
            "telephone_number": "573-290-5888",
            "fax_number": "573-290-5895"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF MISSOURI",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "STATE OF MISSOURI",
        "enumeration_date": "2006-11-03",
        "last_updated": "2020-08-28",
        "certification_date": "2020-08-28",
        "status": "A",
        "authorized_official_last_name": "BOECKMANN",
        "authorized_official_first_name": "MOLLY",
        "authorized_official_middle_name": "JANE",
        "authorized_official_title_or_position": "DIRECTOR OF ADMINSTRATIVE SERVICES",
        "authorized_official_telephone_number": "573-751-4055"
    },
    "taxonomies": [
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": "MO",
            "license": "EXEMPT",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "053445003",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "873445001",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cottonwood Residential Treatment Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Cottonwood Residential Treatment Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cape Girardeau, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.