Equilibrium Ranch
Organization Active NPI Assisted Living Facility (Mental Illness) · Cuba, MO
NPI 1285398024 · NPPES record last updated Jan 3, 2025
Key facts
- NPI
- 1285398024
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Assisted Living Facility (Mental Illness) 3104A0625X
- Legal business name
- EQUILIBRIUM RANCH
- Practice address
- 81 Pilkenton LN
Cuba, MO 65453-8136 - Phone
- (573) 885-6443
- Fax
- (844) 851-0578
- NPI assigned
- Oct 27, 2021
- Organization subpart
- No
Authorized official
- Name
- Christian B Shelton
- Title
- Owner
- Phone
- (314) 580-3029
Practitioners 6
-
Jose Remo, MD
-
Lorna Alise Vaughn, LPC
-
Barbara Appleman Graham, FNP-BC
-
Bridgette Little, PLPC
-
Marvin Shelton, ED.S, ED.D, RSAP
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 26D2179950 | Equilibrium Ranch | Certificate of waiver | Jul 21, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20231026003432 | MO | Part B Supplier - Clinic/Group Practice | 3375999345 |
Receives reassigned benefits from 3 practitioners Practice locations: Cuba, MO |
National Provider Directory
Locations
81 Pilkenton Ln
#705
Cuba, MO 65453
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Manager/Care Coordinator |
171M00000X | |||
| Case Management Agency | 251B00000X | |||
| Assisted Living Facility (Mental Illness) | 3104A0625X | Yes | ||
| Adult Care Home Facility | 311ZA0620X | |||
| Long-Term Care Clinical Nurse Specialist |
364SL0600X | |||
| Personal Care Attendant |
3747P1801X |
Addresses
Primary practice location
81 Pilkenton LN
Cuba, MO 65453-8136
Mailing address
81 Pilkenton LN
Cuba, MO 65453-8136
Phone (573) 885-6443
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003364969 | Medicaid | MO | |
| 1164781373 | Medicaid | MO | |
| 1639213366 | Medicaid | MO | |
| 1841769908 | Medicaid | MO | |
| 1073655619 | Medicaid | MO |
Other providers in Cuba, MO
- Michael Counts
- Crawford Co R-II
- Cuba Manor, Inc.
- Thomas Edward Diehl
- Michelle M. Englert
- Shayla M Farris
- Susan Marie Frago
- Donald James Fuchs
- Thomas L. Gibbon
- Grace Gardens, LLC
All providers in Cuba, MO · Assisted Living Facility (Mental Illness) in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 3, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.