LASTING IMPRESSIONS GROUP HOME (NPI# 1235349614) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1235349614 |
| Entity Type | Organization |
| Organization Name | LASTING IMPRESSIONS GROUP HOME |
| Practice Address |
308 E Smith St Smithton MO 65350-1079 |
| Mailing Address |
Po Box 513 Smithton MO 65350-0513 |
| Practice Telephone | 6603433681 |
| Practice Fax Number | 6603435871 |
| Mailing Telephone | 6603433681 |
| Mailing Fax Number | 6603435871 |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2014-10-07 |
| Authorized Official Name | SHANNON DEE WASSAM (DIRECTOR) |
| Authorized Official Telephone | 6603433681 |
| 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 | Residential Treatment Facilities |
| Street Address |
308 E SMITH ST |
| City | SMITHTON |
| State | MO |
| Zip Code | 65350-1079 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356465033 | Shannon Dee Wassam | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 308 E Smith St, Smithton, MO 65350-1079 | 2007-03-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518031749 | Carolyn Gifford | Specialist | 505 S Myrtle Ave, Smithton, MO 65350-1038 | 2006-11-20 |
| 1992209258 | Melissa Walsh | Speech-Language Pathologist | 505 S Myrtle Ave, Smithton, MO 65350-1038 | 2018-03-21 |
| 1992844450 | Jason Kindle | Specialist | 505 S Myrtle Ave, Smithton, MO 65350-1038 | 2007-02-05 |
| 1699840702 | School District R 6 Smithton | Local Education Agency (LEA) | 505 S Myrtle Ave, Smithton, MO 65350-1038 | 2006-11-22 |
| 1699957662 | Mary Suzanne Meyer | Physical Therapist | 501 S Walnut Ave, Smithton, MO 65350-1097 | 2007-12-03 |
| 1467859215 | Sandra Ross | Occupational Therapy Assistant | 1368 Fox Trot Rd, Smithton, MO 65350-2112 | 2014-11-21 |
| 1710439922 | Shawna Fisher | Registered Nurse | 23525 Highway O, Smithton, MO 65350-3140 | 2016-11-04 |
| 1275679953 | Ronald J Hicken | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 32613 Van Dyke Rd, Smithton, MO 65350-3630 | 2007-01-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942809231 | Progress To Success Speech Therapy Pllc | Speech-Language Pathologist | 4940 Wilderness Pt, Smithton, IL 62285-3664 | 2020-10-19 |
| 1700404035 | Kunevich Chiropractic and Acupuncture, Pllc | Acupuncturist | 13 S Main St Ste 3, Smithton, IL 62285-1705 | 2020-07-13 |
| 1649838277 | Small Talk Speech Therapy, Inc. | Speech-Language Pathologist | 215 Eugenia Dr, Smithton, IL 62285-1425 | 2019-05-29 |
| 1992263123 | Mitchell Ray Buerck | Specialist/Technologist | 4940 Granite Dr, Smithton, IL 62285-3635 | 2019-03-06 |
| 1750845376 | Nicholas A Snyder | Student in an Organized Health Care Education/Training Program | 37 Suzanne Dr, Smithton, IL 62285-1650 | 2019-01-28 |
| 1144730128 | Ashley Marie Hynes | Physician Assistant | 4059 Chestnut Oak Dr, Smithton, IL 62285 | 2017-10-04 |
| 1710439922 | Shawna Fisher | Registered Nurse | 23525 Highway O, Smithton, MO 65350-3140 | 2016-11-04 |
| 1831545540 | Stefanie Banks | Speech-Language Pathologist | 107 S Lincoln St, Smithton, IL 62285-1617 | 2016-05-11 |
| 1326419912 | Smithton Pharmacy Professional Corporation | Pharmacy | 3981 State Route 159, Smithton, IL 62285 | 2015-10-08 |
| 1467859215 | Sandra Ross | Occupational Therapy Assistant | 1368 Fox Trot Rd, Smithton, MO 65350-2112 | 2014-11-21 |
| Find all providers in SMITHTON | ||||
| 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 |
|---|---|---|---|---|
| 1356465033 | Shannon Dee Wassam | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 308 E Smith St, Smithton, MO 65350-1079 | 2007-03-19 |
| 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.