HOME COURT ADVANTAGE V (NPI# 1144402488) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1144402488 |
| Entity Type | Organization |
| Organization Name | HOME COURT ADVANTAGE V |
| Practice Address |
1211 E Broadway St Bolivar MO 65613-2952 |
| Mailing Address |
972 E 433rd Rd Po Box 771 Bolivar MO 65613 |
| Practice Telephone | 4177776980 |
| Practice Fax Number | 4177776981 |
| Mailing Telephone | 4177776980 |
| Mailing Fax Number | 4177776981 |
| Enumeration Date | 2007-11-28 |
| Last Update Date | 2007-11-28 |
| Authorized Official Name | MR. ROBERT MCCRIMMON JR. (ADMINISTRATOR/CEO) |
| Authorized Official Telephone | 4177776980 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320900000X | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | MO | Residential Treatment Facilities |
| Street Address |
1211 E BROADWAY ST |
| City | BOLIVAR |
| State | MO |
| Zip Code | 65613-2952 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053439190 | Home Court Advantage, Inc. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1211 E Broadway St, Bolivar, MO 65613-2952 | 2007-03-27 |
| 1801312459 | Southern Light Residential | Counselor | 1211 E Broadway St, Bolivar, MO 65613-2952 | 2017-08-16 |
| 1346464344 | Home Court Advantage, Inc. | Psychiatric Residential Treatment Facility | 1211 E Broadway St, Bolivar, MO 65613-2952 | 2007-04-12 |
| 1164646162 | Home Court Advantage, Inc. | Psychiatric Residential Treatment Facility | 1211 E Broadway St, Bolivar, MO 65613-2952 | 2007-04-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891301552 | Casablanca Care Center, LLC | Home Health | 524 S. Albany Avenue, Bolivar, MO 65613 | 2020-09-18 |
| 1669087045 | Revive Medical LLC | Durable Medical Equipment & Medical Supplies | 5000, S Scenic, Bolivar, MO 65613 | 2020-09-11 |
| 1669097119 | Melanie Nicole Beckham | Nurse Practitioner | 1100 South Springfield Ave, Suite B, Bolivar, MO 65613 | 2020-06-10 |
| 1932754744 | Caitlin M Williams | Specialist/Technologist | 1260 S Pike Avenue, Bolivar, MO 65613 | 2019-08-08 |
| 1073022406 | Jacquelyn Rose Kemnic | Dietitian, Registered | Heart Center, 1500 N Oakland Ave, Willard, MO 65613 | 2017-09-28 |
| 1164897161 | Ozarks Resource Group | Clinic/Center | 203 E. Broadway St., Bolivar, MO 65613 | 2015-12-02 |
| 1962895292 | Professional Christian Counseling | Counselor | 4888 S 139th Road, Bolivar, MO 65613 | 2015-03-11 |
| 1073916573 | Scott Leslie Dennis | Physician Assistant | 1500 North Oakland Ave, Citizens Memorial Hospital, Bolivar, MO 65613 | 2014-09-29 |
| 1053712109 | Citizens Memorial Hospital District | Pharmacy | 1301-b North Oakland, Bolivar, MO 65613 | 2014-09-09 |
| 1740680453 | Jamee M Stimpson | Occupational Therapist | 454 S. Main Avenue, Bolivar, MO 65613 | 2014-08-29 |
| Find all providers in zip 65613 | ||||
| Taxonomy Code | 320900000X |
| Grouping | Residential Treatment Facilities |
| Classification | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
| A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508915299 | Azare | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 4243 Highway D, Bolivar, MO 65613-9302 | 2007-01-10 |
| 1356726079 | Preferred Family Healthcare, Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 115 E Maupin St, Bolivar, MO 65613-2127 | 2015-07-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609475516 | Brandi Janelle Hickman | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 8706 Newton Ave Apt 4101, Kansas City, MO 64138-5461 | 2020-10-21 |
| 1154935112 | Overcomers Counseling Center Inc | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 17101 East 203rd St, Peculiar, MO 64078 | 2020-09-06 |
| 1386265965 | Candace Palmer | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 2405 Bowe Ln, Jefferson City, MO 65109-9116 | 2020-05-05 |
| 1902426596 | Matt Ferguson | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 4480 Bradley Dr, Joplin, MO 64804-5503 | 2020-04-23 |
| 1689206211 | Insight Industry LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 2501 Ne Prairie Falcon Dr, Blue Springs, MO 64014-1958 | 2020-02-11 |
| 1598306904 | Hearo Technologies LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 405 N Jefferson Ave Ste 1063, Springfield, MO 65806-1110 | 2019-10-07 |
| 1437790219 | Darin Roark | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 2628 Se Kimbrough Ln, Lees Summit, MO 64063-1082 | 2019-10-03 |
| 1942851399 | Wyatt's Dream Center | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 205 State Highway Aa, Sikeston, MO 63801-5303 | 2019-09-26 |
| 1043871908 | Cura Personalis, (care for The Whole Person), LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 11650 Bobwhite Road, Carthage, MO 64836 | 2019-06-21 |
| 1043870181 | Rebuild Contracting LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1783 Possum Hollow Dr, Camdenton, MO 65020-6709 | 2019-06-20 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.