WOODRIDGE OF MISSOURI, INC. (NPI# 1174662720) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174662720 |
| Entity Type | Organization |
| Organization Name | WOODRIDGE OF MISSOURI, INC. |
| Other Organization Name | PINEY RIDGE CENTER |
| Practice Address |
1000 Hospital Road Waynesville MO 65583-4067 |
| Mailing Address |
2520 Northwinds Pkwy Ste 550 Alpharetta GA 30009-2236 |
| Practice Telephone | 5737745353 |
| Practice Fax Number | 5737742907 |
| Mailing Telephone | 4705547903 |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2018-10-11 |
| Authorized Official Name | MR. PAUL LYNN SMITH (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 5737745353 |
| Authorized Official Credential | MS, HSA |
| Is Organization Subpart | Y |
| Parent Organization Name | REP PERIMETER HOLDINGS, LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 324500000X | Substance Abuse Rehabilitation Facility | 000380592 | MO | Residential Treatment Facilities |
| N | 323P00000X | Psychiatric Residential Treatment Facility | 000380592 | MO | Residential Treatment Facilities |
| N | 324500000X | Substance Abuse Rehabilitation Facility | 30888669 | MO | Residential Treatment Facilities |
| N | 324500000X | Substance Abuse Rehabilitation Facility | 3088-11051 | MO | Residential Treatment Facilities |
| Y | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | 000380592 | MO | Residential Treatment Facilities |
| Other Name | Type Code |
|---|---|
| Piney Ridge Center | Doing Business As Name - Organization |
| Street Address |
1000 HOSPITAL ROAD |
| City | WAYNESVILLE |
| State | MO |
| Zip Code | 65583-4067 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972133460 | Fnp4jc, LLC | Family Medicine | 215 North Street, Waynesville, MO 65583 | 2020-01-23 |
| 1134770464 | Patricia Harper | Technician | 25455 Hwy W, Waynesville, MO 65583 | 2019-09-27 |
| 1619430519 | Charles L Quinn | Counselor | Hope Connections LLC 704 Historic Rte. 66w Suite 101, Waynesville, MO 65583 | 2019-04-09 |
| 1801340609 | Nicole Marie Decher | Social Worker | 704 Historic 66 W # 207, Waynesville, MO 65583 | 2016-08-09 |
| 1780952945 | Joseph Benton Isaac | Dentist | 1400 State Rd F, Reznicek Dental Group LLC, Waynesville, MO 65583 | 2011-12-02 |
| 1326325192 | Paul Duane Reznicek | Dentist | 1400 State Rt F, Waynesville, MO 65583 | 2011-11-08 |
| 1629366182 | Bletel Residential Homes | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 18844 Ladera Ln, Waynesville, MO 65583 | 2011-07-19 |
| 1720218126 | Pulaski County Board for The Handicapped | Case Management | 301 Historic Route 66 East, Waynesville, MO 65583 | 2009-07-20 |
| 1447436001 | Joseph Garold Moody | Counselor | 1000 Hospital Road., Piney Ridge Center, Waynesville, MO 65583 | 2008-01-14 |
| 1841404746 | Valencia Sivells | Counselor | 411 Historic Rte 66 West, Waynesville, MO 65583 | 2007-05-09 |
| Find all providers in zip 65583 | ||||
| Taxonomy Code | 322D00000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Emotionally Disturbed Children |
| A provider facility or distinct part of the organization which renders an interdisciplinary program of mental health treatment to individuals under 21 years of age who have persistent dysfunction in major life areas. The dysfunction is of an extent and pervasiveness that requires a protected and highly structured therapeutic environment. These organizations, or distinct part of organizations, exclude those that provide acute psychiatric care, partial hospitalization, group living, therapeutic schooling, primary diagnosis substance abuse disorder treatment, or primary diagnosis mental retardation or developmental disability treatment. |
| Notes: Source: U.S. Department of Defense Regulation 6010.8-R, Chapter 6. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598961765 | Divine Deliverance Counseling Center | Residential Treatment Facility, Emotionally Disturbed Children | 100 S Bates St, Waynesville, MO 65583-2146 | 2007-06-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609474204 | Whetstone Boys Ranch | Residential Treatment Facility, Emotionally Disturbed Children | 6850 County Road 2660, Mountain View, MO 65548-8146 | 2020-10-15 |
| 1962995993 | The Bridge Home for Children | Residential Treatment Facility, Emotionally Disturbed Children | 6033 Swope Pkwy, Kansas City, MO 64130-4461 | 2018-06-13 |
| 1437675477 | Kybama, Inc | Residential Treatment Facility, Emotionally Disturbed Children | 12729 Stoney Point Rd, Bonne Terre, MO 63628 | 2017-08-22 |
| 1568914927 | Clear Creek Counseling | Residential Treatment Facility, Emotionally Disturbed Children | 3646 N Farm Road 89, Willard, MO 65781-8330 | 2016-11-01 |
| 1619330578 | Farmer Grove Homesteads Incorporated | Residential Treatment Facility, Emotionally Disturbed Children | 533 E Bedford St, Marshfield, MO 65706-1218 | 2016-03-29 |
| 1720447212 | Corner Stones of Care | Residential Treatment Facility, Emotionally Disturbed Children | 300 E 36th St, Kansas City, MO 64111-1410 | 2016-02-12 |
| 1558729509 | Cayman's House of Hope, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 311 N Poplar St, Fair Play, MO 65649-9299 | 2016-02-05 |
| 1639503691 | Proverb Academy, Inc | Residential Treatment Facility, Emotionally Disturbed Children | 420 Carroll St, Morehouse, MO 63868 | 2013-08-27 |
| 1306147277 | Fair Haven Children's Home | Residential Treatment Facility, Emotionally Disturbed Children | 3132 N Fair Haven Loop, Strafford, MO 65757-8619 | 2010-11-09 |
| 1437470184 | Ozarks Teen Challenge | Residential Treatment Facility, Emotionally Disturbed Children | 512 Purist Lane, Branson West, MO 65737 | 2010-06-17 |
| Find all providers with the same taxonomy | ||||
| City | WAYNESVILLE |
| Zip Code | 65583 |
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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.