NPIMap

Organization Active NPI

State of Missouri

  • Intellectual Disabilities Intermediate Care Facility
  • Nevada, MO
National Provider Identifier
1376614701
Registry record updated Sep 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
EXEMPT Issued in MO
Legal business name
STATE OF MISSOURI
Practice address
2323 N Ash St
Nevada, MO 64772-1054
Phone
(417) 667-7833
Fax
(417) 448-1138
NPI assigned
Nov 9, 2006
Organization subpart
Yes
Parent organization
STATE OF MISSOURIAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 3, 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 Administrative Services
Phone
(573) 751-4055

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X EXEMPT MO Primary

Addresses

Primary practice location

2323 N Ash St
Nevada, MO 64772-1054

Mailing address

PO Box 687
Jefferson City, MO 65102-0687
Phone (573) 526-6895

Other identifiers 1

IdentifierTypeStateIssuer
051499903MedicaidMO

Other names 1

  • Nevada Habilitation 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 24

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

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599091200000",
    "number": "1376614701",
    "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": "573-526-6895",
            "fax_number": "573-526-4560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2323 N ASH ST",
            "city": "NEVADA",
            "state": "MO",
            "postal_code": "647721054",
            "telephone_number": "417-667-7833",
            "fax_number": "417-448-1138"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF MISSOURI",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "STATE OF MISSOURI",
        "enumeration_date": "2006-11-09",
        "last_updated": "2020-09-03",
        "certification_date": "2020-09-03",
        "status": "A",
        "authorized_official_last_name": "BOECKMANN",
        "authorized_official_first_name": "MOLLY",
        "authorized_official_middle_name": "JANE",
        "authorized_official_title_or_position": "DIRECTOR OF ADMINISTRATIVE SERVICES",
        "authorized_official_telephone_number": "573-751-4055"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "MO",
            "license": "EXEMPT",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "051499903",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Nevada Habilitation Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Nevada Habilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Nevada, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 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.