STATE OF MISSOURI (NPI# 1194933499) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1194933499 |
Entity Type | Organization |
Organization Name | STATE OF MISSOURI |
Other Organization Name | SOUTH COUNTY HABILITATION CENTER |
Practice Address |
2312 Lemay Ferry Rd Saint Louis MO 63125-3127 |
Mailing Address |
1706 E Elm St Jefferson City MO 65101-4130 |
Practice Telephone | 3148945400 |
Mailing Telephone | 5737513398 |
Mailing Fax Number | 5735264560 |
Enumeration Date | 2007-05-18 |
Last Update Date | 2020-08-26 |
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 | 051780104 | 05 |
Other Name | Type Code |
---|---|
South County 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 |
1164630463 | State of Missouri | Intermediate Care Facility, Mentally Retarded | 11 Brady Cir, Overland, MO 63114-1110 | 2007-05-18 |
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 |
Street Address |
2312 LEMAY FERRY RD |
City | SAINT LOUIS |
State | MO |
Zip Code | 63125-3127 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1699812990 | Ramarao Kaza | Urology | 2312 Lemay Ferry Rd, Saint Louis, MO 63125-3127 | 2007-01-30 |
1649399403 | Valerie Jean Allen Foster | Registered Nurse | 2312 Lemay Ferry Rd, Saint Louis, MO 63125-3127 | 2007-03-29 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1396396990 | Linda Marie Monken | Technician | 3792 Southern Manor, St. Louis, MO 63125 | 2019-09-25 |
1194373688 | Angel Angelette Rochelle Ellington | Technician | Va St Louis Spinal Cord Injury Unit, 1 Jefferson Barracks Drive 128/jb, St Louis, MO 63125 | 2019-08-28 |
1760940209 | Lea-ed Inc | Community Based Residential Treatment Facility, Mental Illness | 30 Sherman Road, Lemay, MO 63125 | 2019-03-04 |
1861957185 | Mary M Ross | Occupational Therapist | Sherbrooke Village, 4005 Ripa Ave, St. Louis, MO 63125 | 2019-02-01 |
1013400977 | Anne Henry Francis | Dietitian, Registered | Va St. Louis Health Care System, 1 Jefferson Barracks Drive, St. Louis, MO 63125 | 2018-06-14 |
1922458660 | Rebecca Mae Waugh | Skilled Nursing Facility | 1001 Holy Grail Ct, Saint Louis, MO 63125 | 2016-06-14 |
1942661814 | Dsk Works LLC | Chiropractor | 3193 Lemay Ferry Rd., Saint Louis, MO 63125 | 2016-03-18 |
1467717678 | Despine Louise Coulis | Pediatrics | 7545 S Lindbergh Blvd Ste 220, Saint Louis, MO 63125 | 2012-07-13 |
1184914194 | Allison Celeste Cassidy | Pharmacist | 3901 Lemay Ferry Road, Saint Louis, MO 63125 | 2011-04-11 |
1093049694 | Lauren C Mensie | Psychologist | 1 Jefferson Barracks Dr., 116b/jb St. Louis Va Medical Center, St. Louis, MO 63125 | 2009-09-29 |
Find all providers in zip 63125 |
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 |
---|---|---|---|---|
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 |
1770866030 | State of Missouri | Intermediate Care Facility, Mentally Retarded | 10695 Bellefontaine Rd, Saint Louis, MO 63137-2315 | 2011-09-23 |
1760553101 | State of Missouri | Intermediate Care Facility, Mentally Retarded | 10695 Bellefontaine Rd, Saint Louis, MO 63137-2315 | 2006-11-09 |
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 |
1164630463 | State of Missouri | Intermediate Care Facility, Mentally Retarded | 11 Brady Cir, Overland, MO 63114-1110 | 2007-05-18 |
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 |
1861563298 | State of Missouri | Intermediate Care Facility, Mentally Retarded | 700 E Slater St, Marshall, MO 65340-1240 | 2006-11-09 |
1598844029 | State of Missouri | Intermediate Care Facility, Mentally Retarded | 112 Plaza Dr, Sikeston, MO 63801-5137 | 2006-11-03 |
1083073498 | Dillahunt Enterprises, LLC | Intermediate Care Facility, Mentally Retarded | 4300 Royal Aberdeen St, Columbia, MO 65203-4810 | 2016-02-12 |
1841452109 | Evergreen Group Home | Intermediate Care Facility, Mentally Retarded | 27 Hopper Trl, Urbana, MO 65767-9234 | 2008-06-27 |
Find all providers with the same taxonomy |
City | SAINT LOUIS |
Zip Code | 63125 |
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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.