NPIMap

Organization Active NPI

Southeast Missouri State University

  • Developmentally Disabled Services Day Training Agency
  • Cape Girardeau, MO
National Provider Identifier
1780753640
Registry record updated Feb 15, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X
License
581 Issued in MO
Legal business name
SOUTHEAST MISSOURI STATE UNIVERSITY
Doing business as
Horizons Enrichment Center
Practice address
2100 Themis St Ste 103C
Cape Girardeau, MO 63701-5124
Phone
(573) 290-5115
Fax
(573) 290-5115
NPI assigned
Nov 7, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2019

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

Authorized official

Name
Mrs. Tracy Lynne Owens, BSPA
Title
Executive Director
Phone
(573) 290-5115

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Developmentally Disabled Services Day Training Agency 251C00000X 581 MO Primary

Addresses

Primary practice location

2100 Themis St Ste 103C
Cape Girardeau, MO 63701-5124

Mailing address

2100 Themis St Ste 103C
Cape Girardeau, MO 63701-5124
Phone (573) 290-5115

Other identifiers 1

IdentifierTypeStateIssuer
295248306MedicaidMO

Other names 1

  • Horizons Enrichment Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Horizons Enrichment Center4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

NPI Registry JSON

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

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1550188800000",
    "number": "1780753640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 THEMIS ST STE 103C",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "637015124",
            "telephone_number": "573-290-5115",
            "fax_number": "573-290-5115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 THEMIS ST STE 103C",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "637015124",
            "telephone_number": "573-290-5115",
            "fax_number": "573-290-5115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST MISSOURI STATE UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-07",
        "last_updated": "2019-02-15",
        "status": "A",
        "authorized_official_last_name": "OWENS",
        "authorized_official_first_name": "TRACY",
        "authorized_official_middle_name": "LYNNE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "573-290-5115",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "BSPA"
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "MO",
            "license": "581",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "295248306",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Horizons Enrichment Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Horizons Enrichment Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cape Girardeau, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2019; 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.