Lacey Ann Skelton, LEVEL 1 MED AIDE
Individual provider Active NPI Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Eminence, MO
NPI 1457027419 · NPPES record last updated Oct 5, 2021
Key facts
- NPI
- 1457027419
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X
- License
- 049124 (MO)
- Practice address
- 18941 CR 305a
Eminence, MO 65466-6268 - Phone
- (573) 226-5426
- Fax
- (573) 226-5426
- NPI assigned
- Aug 19, 2021
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Education
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 049124 | MO | MD | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lacey Ann Skelton | Community Based Residential Treatment Facility, Intellectual and/Or Developmental Disabilities | Current |
Accepting new patients |
Locations
18941 CR 305a
Eminence, MO 65466
Phone (573) 226-5426
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility | 320900000X | 049124 | MO | Yes |
Addresses
Primary practice location
18941 CR 305a
Eminence, MO 65466-6268
Mailing address
18941 CR 305a
Eminence, MO 65466-6268
Phone (573) 226-5426
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 84-1730316 | Medicaid | MO |
Other providers in Eminence, MO
- Regional Services
- Shannon County Health Center
- Shannon County Health Center
- Shannon County Health Center
- Shannon County Health Center
All providers in Eminence, MO · Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 5, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.