Nickles Private Probation Services LLC

Primary specialty

Recovery Care Clinic/CenterTaxonomy code 261QR0800X

Legal business name

NICKLES PRIVATE PROBATION SERVICES LLC

Practice address

205 3Rd St
Steelville, MO 65565-5054

Phone

(573) 712-5145

Fax

(630) 305-9287

NPI assigned

Jun 7, 2024

Organization subpart

No

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

Authorized official

Name

Mr. Kenneth Lee Nickles Jr.

Title

Sole Member

Phone

(573) 712-5145

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1717718400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717718400000",
    "number": "1215779665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1325",
            "city": "STEELVILLE",
            "state": "MO",
            "postal_code": "655651325",
            "telephone_number": "573-712-5145",
            "fax_number": "630-604-9287"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 3RD ST",
            "city": "STEELVILLE",
            "state": "MO",
            "postal_code": "655655054",
            "telephone_number": "573-712-5145",
            "fax_number": "630-305-9287"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "114 E High St",
            "address_purpose": "LOCATION",
            "city": "Potosi",
            "state": "MO",
            "postal_code": "636641907",
            "country_code": "US",
            "telephone_number": "573-712-5145",
            "fax_number": "630-305-9287",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NICKLES PRIVATE PROBATION SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-07",
        "last_updated": "2024-06-07",
        "certification_date": "2024-06-07",
        "status": "A",
        "authorized_official_last_name": "NICKLES",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "SOLE MEMBER",
        "authorized_official_telephone_number": "573-712-5145",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "261QR0800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Recovery Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2024; 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.