NPI 1164630463

State of Missouri

Organisation Intellectual Disabilities Intermediate Care Facility Overland, MO

Practice location

Address: 11 Brady Cir, Overland, MO 63114-1110
Phone: (314) 428-8470
Mailing address: 1706 E Elm St, Jefferson City, MO 65101-4130

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

Other Intermediate Care Facility, Intellectual Disabilities providers in Missouri →

Registry record

NPI: 1164630463
Entity type: Organization
NPI issued: 18 May 2007
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.