NPI 1124198981

State of Missouri

Organisation Intellectual Disabilities Intermediate Care Facility Poplar Bluff, MO

Practice location

Address: 2351 Kanell Blvd, Poplar Bluff, MO 63901-4035
Phone: (573) 840-9370
Fax: (573) 840-9373
Mailing address: PO Box 687, Jefferson City, MO 65102-0687

Authorised official

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

Registered specialties

Intellectual Disabilities Intermediate Care Facility Primary

Nursing & Custodial Care Facilities Taxonomy 315P00000X Licence EXEMPT (MO)

Other Intermediate Care Facility, Intellectual Disabilities providers in Missouri →

Registry record

NPI: 1124198981
Entity type: Organization
NPI issued: 9 Nov 2006
Record last updated: 27 Oct 2020

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.