National Provider Identifier Database

STATE OF MISSOURI
Intermediate Care Facility, Mentally Retarded

(1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals.


Contact Information

STATE OF MISSOURI
700 E SLATER ST
MARSHALL, MO65340-1240
Phone: 660-886-2201
Fax: 660-831-3071
Website:
Specialty Taxonomy Code
* Intermediate Care Facility, Mentally Retarded 315P00000X

* Indicates primary specialty

NPI Profile & details for STATE OF MISSOURI

NPI Number 1861563298
Legal business name
LBN
STATE OF MISSOURI
Authorized official MOLLY BOECKMANN - (DIRECTOR OF ADMINISTRATIVE SERVICES)
Entity Organization
Organization subpart Yes
Enumeration date 11/09/2006
Last updated 10/20/2020 - About 6 years ago
Sole proprietor1 Not specified
Identifiers
  • MO License #: EXEMPT
  • MO Medicaid: 051499804

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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