STATE OF MISSOURI (NPI# 1376614701) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376614701 |
| Entity Type | Organization |
| Organization Name | STATE OF MISSOURI |
| Other Organization Name | NEVADA HABILITATION CENTER |
| Practice Address |
2323 N Ash St Nevada MO 64772-1054 |
| Mailing Address |
Po Box 687 Jefferson City MO 65102-0687 |
| Practice Telephone | 4176677833 |
| Practice Fax Number | 4174481138 |
| Mailing Telephone | 5735266895 |
| Mailing Fax Number | 5735264560 |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2020-09-03 |
| 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 | EXEMPT | MO | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 051499903 | 05 |
| Other Name | Type Code |
|---|---|
| Nevada 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 |
2323 N ASH ST |
| City | NEVADA |
| State | MO |
| Zip Code | 64772-1054 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114971702 | State of Missouri | Psychiatry & Neurology | 2323 N Ash St, Nevada, MO 64772-1054 | 2006-05-19 |
| 1811137516 | State of Missouri | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 2323 N Ash St, Nevada, MO 64772-1054 | 2009-02-20 |
| 1588713853 | Inn T Park | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 2323 N Ash St, Nevada, MO 64772-1054 | 2007-01-09 |
| 1013940469 | Lewis Shilane | Family Medicine | 2323 N Ash St, Nevada Habilitation Center, Nevada, MO 64772-1054 | 2006-07-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184116170 | Elizabeth Hoang | Dentist | 14054 Us-54, Nevada, MO 64772 | 2018-06-05 |
| 1376056424 | Chelsea Deines | Social Worker | 19940 S. 1481 Road, Nevada, MO 64772 | 2017-11-13 |
| 1558712422 | Ozark Tri County Healthcare Consortium | Dentist | 204 N Cedar, Nevada, MO 64772 | 2016-06-22 |
| 1144605312 | Nevada City Hospital | Clinic/Center | 627 S Ash St Ste B, Nevada, MO 64772 | 2015-07-29 |
| 1205233129 | Julie Ann Parker | Dental Hygienist | 204 North Cedar, Nevada, MO 64772 | 2014-11-20 |
| 1023432101 | Ashley Mckinney | Speech-Language Pathologist | 811 W Hickory, Nevada, MO 64772 | 2014-02-11 |
| 1477975183 | Krc 1505 Health Care Services LLC | Assisted Living Facility | 1505 East Ashland Street, Nevada, MO 64772 | 2014-01-15 |
| 1649520727 | Kathy J Hallam | Registered Nurse | 320 N Mac Boulevard, Nevada, MO 64772 | 2012-09-14 |
| 1396090916 | Emily Lane | Speech-Language Pathologist | 16927 S 1413 Rd, Nevada, MO 64772 | 2012-07-19 |
| 1427385517 | Nevada City Hospital | Clinic/Center | 345 S Barrett Ln., Nevada, MO 64772 | 2009-11-10 |
| Find all providers in zip 64772 | ||||
| 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 |
|---|---|---|---|---|
| 1851666820 | Mosaic | Intermediate Care Facility, Mentally Retarded | 718 S 13th St, Nevada, IA 50201-2435 | 2012-03-09 |
| 1629344502 | Mosaic | Intermediate Care Facility, Mentally Retarded | 1031 Shagbark Dr, Nevada, IA 50201-2705 | 2012-03-26 |
| 1275809147 | Mosaic | Intermediate Care Facility, Mentally Retarded | 1947 8th St, Nevada, IA 50201-1213 | 2012-03-26 |
| 1629344510 | Mosaic | Intermediate Care Facility, Mentally Retarded | 217 Maple Ave, Nevada, IA 50201 | 2012-03-26 |
| 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 |
| 1164630463 | State of Missouri | Intermediate Care Facility, Mentally Retarded | 11 Brady Cir, Overland, MO 63114-1110 | 2007-05-18 |
| 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 |
| 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.