NPI 1316017056

State of Missouri

Organisation Case Management Agency Sikeston, MO

Practice location

Address: 112 Plaza Dr, Sikeston, MO 63801-5137
Phone: (573) 472-5300
Fax: (573) 472-5308
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

Case Management Agency Primary

Agencies Taxonomy 251B00000X Licence EXEMPT (MO)

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Registry record

NPI: 1316017056
Entity type: Organization
NPI issued: 9 Nov 2006
Record last updated: 20 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.