NPI 1598844029

State of Missouri

Organisation Intellectual Disabilities Intermediate Care Facility Sikeston, MO

Practice location

Address: 112 Plaza Dr, Sikeston, MO 63801-5137
Phone: (573) 472-5300
Fax: (573) 472-5308
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: 1598844029
Entity type: Organization
NPI issued: 3 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.