State of Missouri

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

STATE OF MISSOURI

Doing business as

Nevada Habilitation Center ISL

Practice address

2323 N Ash St
Nevada, MO 64772-1054

Phone

(417) 667-7833

Fax

(417) 448-1146

NPI assigned

Feb 20, 2009

Last updated

Aug 28, 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

• Nevada Habilitation Center ISL 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 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
• State of Missouri

  dba Marshall Habilitation Center-Home 4

  • Developmentally Disabled Services Day Training Agency
  • Slater, MO
  • NPI 1730249335
  NPD tax ID
• State of Missouri

  dba Fulton State Hospital

  • Case Management Agency
  • Fulton, MO
  • NPI 1740491539
  NPD tax ID
• State of Missouri

  dba Southeast Missouri Residential Services-Poplar Bluff Prof Grp

  • Family Medicine Physician
  • Poplar Bluff, MO
  • NPI 1740560580
  NPD tax ID
• State of Missouri

  dba Northwest MO PRC Pharmacy

  • Long Term Care Pharmacy
  • Saint Joseph, MO
  • NPI 1750420188
  NPD tax ID
• State of Missouri

  dba Bellefontaine Habilitation Center

  • Intellectual Disabilities Intermediate Care Facility
  • Saint Louis, MO
  • NPI 1760553101
  NPD tax ID
• State of Missouri

  dba Highlands Group Home

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Independence, MO
  • NPI 1760681415
  NPD tax ID
• State of Missouri

  dba Bellefontaine Habilitaion Center-Waiver Services

  • Intellectual Disabilities Intermediate Care Facility
  • Saint Louis, MO
  • NPI 1770866030
  NPD tax ID
• State of Missouri

  dba Rolla Regional Center

  • Developmentally Disabled Services Day Training Agency
  • Rolla, MO
  • NPI 1790851756
  NPD tax ID
• State of Missouri

  dba Ccbho

  • Community/Behavioral Health Agency
  • Jefferson City, MO
  • NPI 1801422621
  NPD tax ID

Locations

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

{
    "created_epoch": "1235088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598572800000",
    "number": "1811137516",
    "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": "651014130",
            "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": "2323 N ASH ST",
            "city": "NEVADA",
            "state": "MO",
            "postal_code": "647721054",
            "telephone_number": "417-667-7833",
            "fax_number": "417-448-1146"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF MISSOURI",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "STATE OF MISSOURI",
        "enumeration_date": "2009-02-20",
        "last_updated": "2020-08-28",
        "certification_date": "2020-08-28",
        "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": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Nevada Habilitation Center ISL",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Nevada Habilitation Center ISL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sports Plus Inc
• Peggy Stark, LCSW
• State of Missouri (Nevada Habilitation Center)
• State of Missouri (Nevada Habilitation Center)
• State of Missouri (Nevada Habilitation Center-Crisis)
• Esther Stetson, DDS
• Amber Stout, LMSW
• Summers Pharmacy of Nevada LLC
• Summers Pharmacy of Nevada LLC (Community Pharmacy - Long-Term Care)
• Supportive Spaces Counseling

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Nevada, MO
• Providers in Nevada, MO by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 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.