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State of Missouri

Organization Active NPI Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Higginsville, MO

NPI 1487931358 · NPPES record last updated Aug 28, 2020

Key facts

NPI
1487931358
Entity type
Organization (NPI type 2)
Primary specialty
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X
Legal business name
STATE OF MISSOURI
Practice address
100 W 1St St
Higginsville, MO 64037-1171
Phone
(660) 584-2142
Fax
(660) 584-6244
NPI assigned
Nov 7, 2011
Organization subpart
Yes
Parent organization (as reported)
STATE OF MISSOURI

Authorized official

Name
Molly Jane Boeckmann
Title
Director of Administrative Services
Phone
(573) 751-4055

Corporate family (same tax ID) 24

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

National Provider Directory

Tax ID family
Southwest Missouri Psy (104 organizations share this tax ID)
Part of
Southwest Missouri Psy

Specialties & licenses

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

Addresses

Primary practice location

100 W 1St St
Higginsville, MO 64037-1171

Mailing address

1706 E Elm St Attn Reimbursements
PO Box 687
Jefferson City, MO 65102-0687
Phone (573) 751-3398

Other names

  • Higginsville Habilitation Center-Crisis Doing business as

Other providers in Higginsville, MO

All providers in Higginsville, MO · Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Missouri

Sources for this page

Verify at the official NPI Registry.