STATE OF MISSOURI (NPI# 1164630463) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164630463 |
| Entity Type | Organization |
| Organization Name | STATE OF MISSOURI |
| Other Organization Name | NORTH WEST HABILITATION CENTER |
| Practice Address |
11 Brady Cir Overland MO 63114-1110 |
| Mailing Address |
1706 E Elm St Jefferson City MO 65101-4130 |
| Practice Telephone | 3144288470 |
| Mailing Telephone | 5737513398 |
| Mailing Fax Number | 5735264560 |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2020-10-27 |
| Authorized Official Name | MOLLY JANE BOECKMANN (DIRECTOR OF ADMINISTRATIVE SERVICES) |
| Authorized Official Telephone | 5737514055 |
| Is Organization Subpart | Y |
| Parent Organization Name | STATE OF MISSOURI |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 315P00000X | Intermediate Care Facility, Mentally Retarded | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 052361904 | 05 |
| Other Name | Type Code |
|---|---|
| North West Habilitation Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437781499 | State of Missouri | Rehabilitation Counselor | 3418 Knipp Dr, Jefferson City, MO 65109-5701 | 2020-02-07 |
| 1275073280 | State of Missouri | General Practice | 1547 W Commerce Drive, Marshall, MO 65340-3907 | 2017-02-24 |
| 1528333085 | State of Missouri | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1000 N Colorado St, Nevada, MO 64772-1618 | 2012-03-16 |
| 1386843621 | State of Missouri | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 15555 Little Blue Rd, Kansas City, MO 64139 | 2007-07-17 |
| 1922207679 | State of Missouri | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 5410 Rinker Rd, Kansas City, MO 64129-2308 | 2007-07-13 |
| 1760681415 | State of Missouri | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1501 N River Blvd, Independence, MO 64050-1760 | 2007-07-13 |
| 1548322605 | State of Missouri | Day Training, Developmentally Disabled Services | 1500 Vandiver Dr Ste 100, Columbia, MO 65202-3932 | 2006-12-15 |
| 1366503153 | State of Missouri | Day Training, Developmentally Disabled Services | 471 E Slater St, Marshall, MO 65340 | 2006-12-13 |
| 1427118033 | State of Missouri | Day Training, Developmentally Disabled Services | 522 Star St, Marshall, MO 65340 | 2006-12-12 |
| 1902966500 | State of Missouri | Day Training, Developmentally Disabled Services | 504 N Elm St, Marshall, MO 65340 | 2006-12-12 |
| Street Address |
11 BRADY CIR |
| City | OVERLAND |
| State | MO |
| Zip Code | 63114-1110 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053926964 | Deann Porter | Prosthetist | 8743 Mavis Place, St Louis, MO 63114 | 2020-09-09 |
| 1255971438 | Hughes In Home Services | Home Health | 9319 Midland Ste B, St Louis, MO 63114 | 2020-01-15 |
| 1740714724 | Catherine Kagotho | Nurse Practitioner | 9915 Broadmoor Dr, Apt 4, Overland, MO 63114 | 2017-04-17 |
| 1073051371 | Ruth & Naomi Adult Day Services, Inc | Clinic/Center | 9443-9445 Lackland Road, St. Louis, MO 63114 | 2017-02-07 |
| 1992103691 | Lisa Abernathy | Social Worker | 9705 Tennyson Court, Saint Louis, MO 63114 | 2014-12-11 |
| 1356626808 | William J Norbury | Pharmacist | 8000 St. Charles Rock Road, Walgreens Pharmacy 4825, St.louis, MO 63114 | 2011-10-17 |
| 1770719700 | Total Renal Care Inc | Clinic/Center | 9030 Saint Charles Rock Rd, Saint Louis, MO 63114 | 2009-06-04 |
| 1710126792 | Risingabove Independent Supported Living | Assisted Living Facility | 2330 # 2 Woodson Road, Overland, MO 63114 | 2009-02-13 |
| 1427215789 | Wnf Medical, LLC | Durable Medical Equipment & Medical Supplies | 1908-2000 Innerhelt Business Center Dr., Suite 1968, Overland, MO 63114 | 2008-05-22 |
| 1891838744 | Easter Seals Midwest | Day Training, Developmentally Disabled Services | 2215 Lackland Road, Overland, MO 63114 | 2007-02-14 |
| Find all providers in zip 63114 | ||||
| Taxonomy Code | 315P00000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | 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. |
| Notes: Sources: (1) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, IL: 1994, p. 403 (2) Paraphrased from Code of Federal Regulations #42, Public Health, Section 440.150(c). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699213603 | Equilibrium Homes of St. Louis LLC | Intermediate Care Facility, Mentally Retarded | 3054 Sir Christopher Ln, Florissant, MO 63033-3114 | 2017-02-09 |
| 1164657664 | Caring Hands LLC | Intermediate Care Facility, Mentally Retarded | 2832 558th Rd, Albany, MO 64402-8138 | 2009-05-27 |
| 1477788966 | Loving Orchards Homes | Intermediate Care Facility, Mentally Retarded | 1400 Sw Merryman Dr, Lees Summit, MO 64082-3906 | 2009-05-27 |
| 1073771358 | Magdala Foundation | Intermediate Care Facility, Mentally Retarded | 3117 Maury Ave, Saint Louis, MO 63116-2021 | 2008-05-23 |
| 1619135985 | Magdala Foundation | Intermediate Care Facility, Mentally Retarded | 7400 Augusta Ave, Saint Louis, MO 63121-4802 | 2008-05-23 |
| 1255599528 | Magdala Foundation | Intermediate Care Facility, Mentally Retarded | 4242 Russell Blvd, Saint Louis, MO 63110-3511 | 2008-05-23 |
| 1619135993 | Magdala Foundation | Intermediate Care Facility, Mentally Retarded | 3900 Canterbury Dr, Saint Louis, MO 63121-2500 | 2008-05-23 |
| 1376667469 | Focus On Residential Services Dba Lafayette Habilitation Center | Intermediate Care Facility, Mentally Retarded | 2701 Henrietta St, Saint Louis, MO 63104-2007 | 2007-03-16 |
| 1336273069 | Manor Home | Intermediate Care Facility, Mentally Retarded | 107 Nanette St, Belton, MO 64012-3032 | 2007-03-15 |
| 1760557763 | Cameron Group Care, Inc | Intermediate Care Facility, Mentally Retarded | 625 Harris Ln, Cameron, MO 64429-1121 | 2006-11-22 |
| 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.