NPIMap

Organization Active NPI

Diana's Boarding Home 2 Inc.

  • Mental Illness Community Based Residential Treatment Facility
  • Marble Hill, MO
National Provider Identifier
1306438825
Registry record updated Feb 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
Legal business name
DIANA'S BOARDING HOME 2 INC.
Practice address
HC 64 4677
Marble Hill, MO 63764
Phone
(573) 238-3344
Fax
(573) 238-3361
NPI assigned
Feb 5, 2021
Last updated
Feb 5, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2021

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

Authorized official

Name
Terry Dustin Wagner
Title
Owner/President
Phone
(573) 238-3344

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X Primary

Addresses

Primary practice location

HC 64 4677
Marble Hill, MO 63764

Mailing address

HC 64 Box 4677
Marble Hill, MO 63764
Phone (573) 238-3344

National Provider Directory

National Provider Directory
Tax ID family
Diana's Boarding Home 2 Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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": "1612483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612483200000",
    "number": "1306438825",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "HC 64 BOX 4677",
            "city": "MARBLE HILL",
            "state": "MO",
            "postal_code": "63764",
            "telephone_number": "573-238-3344",
            "fax_number": "573-238-3361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "HC 64 4677",
            "city": "MARBLE HILL",
            "state": "MO",
            "postal_code": "63764",
            "telephone_number": "573-238-3344",
            "fax_number": "573-238-3361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIANA'S BOARDING HOME 2 INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-05",
        "last_updated": "2021-02-05",
        "certification_date": "2021-02-05",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "TERRY",
        "authorized_official_middle_name": "DUSTIN",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "573-238-3344"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marble Hill, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2021; 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.