Maple Crest Residential Care Facility

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

Legal business name

MAPLE CREST RESIDENTIAL CARE FACILITY

Practice address

307 N Broadway St
Poplar Bluff, MO 63901-5103

Phone

(573) 686-4490

Fax

(573) 686-8817

NPI assigned

Mar 7, 2008

Organization subpart

No

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

Authorized official

Name

Mr. Mark Allen Keeney

Title

Owner

Phone

(573) 686-4490

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1204848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204848000000",
    "number": "1619147428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "307 N BROADWAY ST",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639015103",
            "telephone_number": "573-686-4490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "307 N BROADWAY ST",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639015103",
            "telephone_number": "573-686-4490",
            "fax_number": "573-686-8817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAPLE CREST RESIDENTIAL CARE FACILITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-07",
        "last_updated": "2008-03-07",
        "status": "A",
        "authorized_official_last_name": "KEENEY",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "573-686-4490",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "MO",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Illness Community Based Residential Treatment Facility in Poplar Bluff, MO
• Providers in Poplar Bluff, MO by specialty
• Mental Illness Community Based Residential Treatment Facility in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2008; 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.