STATE OF MISSOURI


Address: 2312 Lemay Ferry Rd, Saint Louis, MO 63125-3127
Phone: 3148945400

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).

Provider Overview

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

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 315P00000X Intermediate Care Facility, Mentally Retarded Nursing & Custodial Care Facilities

Other Provider Identifier

State Issuer Identifier Type Code
MO 051780104 05

Other Provider/Organization Names

Other Name Type Code
South County Habilitation Center Doing Business As Name - Organization

Other Provider IDs and Locations

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

Office Location

Street Address 2312 LEMAY FERRY RD
City SAINT LOUIS
State MO
Zip Code 63125-3127

Providers in the same location

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

Providers in the same zip code

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 Information

Taxonomy Code 315P00000X
Grouping Nursing & Custodial Care Facilities
Classification Intermediate Care Facility, Mentally Retarded

Taxonomy Definition

(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).

Providers in the same taxonomy and city

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

Providers in the same taxonomy and state

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

Competitor

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City SAINT LOUIS
Zip Code 63125

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Dataset Information

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.

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