State of Missouri

Primary specialty

Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X

Legal business name

STATE OF MISSOURI

Doing business as

Marshall Habilitation Center-Home 4

Practice address

538 Euclid St
Slater, MO 65349

Phone

(660) 886-2201

Fax

(660) 831-3071

NPI assigned

Dec 12, 2006

Last updated

Aug 31, 2020By the provider in NPPES

Organization subpart

Yes

Parent organization

STATE OF MISSOURIAs reported in NPPES

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

Addresses

Other names 1

• Marshall Habilitation Center-Home 4 Doing business as

Tax ID family

Missouri Tuberculosis Lab104 organizations share this tax ID, including this one

Part of

Missouri Tuberculosis Lab

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.

• State of Missouri

  dba Southeast Missouri Residential Services ISL

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Poplar Bluff, MO
  • NPI 1598906372
  NPD tax ID
• State of Missouri

  dba Center for Behavioral Health

  • Case Management Agency
  • Kansas City, MO
  • NPI 1609087584
  NPD tax ID
• State of Missouri

  dba Paseo Clinic

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Kansas City, MO
  • NPI 1609954809
  NPD tax ID
• State of Missouri

  dba Metropolitan SL PC Pharmcy

  • Long Term Care Pharmacy
  • Saint Louis, MO
  • NPI 1619016862
  NPD tax ID
• State of Missouri

  dba Southeast Missouri Mental Health Center Pharmacy

  • Institutional Pharmacy
  • Farmington, MO
  • NPI 1669511093
  NPD tax ID
• State of Missouri

  dba Southeast Missouri Mental Health Center

  • Case Management Agency
  • Farmington, MO
  • NPI 1669683439
  NPD tax ID
• State of Missouri

  dba Higginsville Habilitation Center

  • Intellectual Disabilities Intermediate Care Facility
  • Higginsville, MO
  • NPI 1689745010
  NPD tax ID
• State of Missouri

  dba St Louis Regional Center

  • Developmentally Disabled Services Day Training Agency
  • Saint Louis, MO
  • NPI 1710053780
  NPD tax ID
• State of Missouri

  dba Albany Regional Center

  • Case Management Agency
  • Albany, MO
  • NPI 1710056759
  NPD tax ID
• State of Missouri

  dba Bellefontaine Habilitation Center

  • Physical Medicine & Rehabilitation Physician
  • Saint Louis, MO
  • NPI 1710931167
  NPD tax ID
• State of Missouri

  dba Higginsville ISL II

  • Developmentally Disabled Services Day Training Agency
  • Higginsville, MO
  • NPI 1720140148
  NPD tax ID
• State of Missouri

  dba Center for Behavioral Medicine

  • Psychiatric Hospital
  • Kansas City, MO
  • NPI 1730134495
  NPD tax ID

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

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598832000000",
    "number": "1730249335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1706 E ELM ST",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651020687",
            "telephone_number": "573-751-3398",
            "fax_number": "573-526-4560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "538 EUCLID ST",
            "city": "SLATER",
            "state": "MO",
            "postal_code": "65349",
            "telephone_number": "660-886-2201",
            "fax_number": "660-831-3071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF MISSOURI",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "STATE OF MISSOURI",
        "enumeration_date": "2006-12-12",
        "last_updated": "2020-08-31",
        "certification_date": "2020-08-31",
        "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": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Marshall Habilitation Center-Home 4",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Marshall Habilitation Center-Home 4",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Missouri Valley Regional Medical Center, LLC
• Matthew William Oxford, MD
• Renowned Chiropractic LLC
• Slater Ambulance District
• Slater Public School
• Summers Pharmacy of Slater, LLC
• George Philip Wymore, DDS

• Developmentally Disabled Services Day Training Agency in Slater, MO
• Providers in Slater, MO by specialty
• Developmentally Disabled Services Day Training Agency in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 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.