NPIMap

Organization Active NPI

Southeast Missouri State University

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Cape Girardeau, MO
National Provider Identifier
1295014470
Registry record updated Feb 15, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X
Legal business name
SOUTHEAST MISSOURI STATE UNIVERSITY
Doing business as
Horizons Enrichment Center
Practice address
2100 Themis St Ste 103C
Cape Girardeau, MO 63701-5124
Phone
(573) 290-5115
Fax
(573) 290-5142
NPI assigned
Aug 5, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2019

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

Authorized official

Name
Mrs. Tracy Lynne Owens, BSPA
Title
Director
Phone
(573) 290-5115

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X Primary

Addresses

Primary practice location

2100 Themis St Ste 103C
Cape Girardeau, MO 63701-5124

Mailing address

2100 Themis St Ste 103C
Cape Girardeau, MO 63701-5124
Phone (573) 290-5115

Other identifiers 1

IdentifierTypeStateIssuer
1780753640MedicaidMO

Other names 1

  • Horizons Enrichment Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Horizons Enrichment Center4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1312502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1550188800000",
    "number": "1295014470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 THEMIS ST STE 103C",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "637015124",
            "telephone_number": "573-290-5115",
            "fax_number": "573-290-5142"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 THEMIS ST STE 103C",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "637015124",
            "telephone_number": "573-290-5115",
            "fax_number": "573-290-5142"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST MISSOURI STATE UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-05",
        "last_updated": "2019-02-15",
        "status": "A",
        "authorized_official_last_name": "OWENS",
        "authorized_official_first_name": "TRACY",
        "authorized_official_middle_name": "LYNNE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "573-290-5115",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "BSPA"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1780753640",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Horizons Enrichment Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Horizons Enrichment 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 Feb 15, 2019; 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.