STATE OF MISSOURI (NPI# 1427124494) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1427124494 |
| Entity Type | Organization |
| Organization Name | STATE OF MISSOURI |
| Other Organization Name | MARSHALL HABILITATION CENTER-HOME 5 |
| Practice Address |
1503 S Grant Ave Marshall MO 65340-2922 |
| Mailing Address |
1706 E Elm St Jefferson City MO 65101-4130 |
| Practice Telephone | 6608862201 |
| Practice Fax Number | 6608313071 |
| Mailing Telephone | 5737513398 |
| Mailing Fax Number | 5735264560 |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2020-10-20 |
| 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 | 251C00000X | Day Training, Developmentally Disabled Services | EXEMPT | MO | Agencies |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 853529501 | 05 |
| Other Name | Type Code |
|---|---|
| Marshall Habilitation Center-Home 5 | 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 |
1503 S GRANT AVE |
| City | MARSHALL |
| State | MO |
| Zip Code | 65340-2922 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336791847 | Gerald D Robertson | Chiropractor | 1566 S Odell Ave, Marshall, MO 65340 | 2019-07-15 |
| 1659860765 | William L Pearman | Nurse Practitioner | Marshall Emergency Physicians, 2305 South Highway 65, Marshall, MO 65340 | 2018-05-03 |
| 1992204978 | Susan Elizabeth Lichtenberg | Speech-Language Pathologist | 860 W. Vest St., Marshall, MO 65340 | 2018-02-06 |
| 1568974616 | Falin Kay Larsen | Family Medicine | 2303 Us-65, Marshal, MO 65340 | 2017-10-30 |
| 1881132587 | Dana Zinn | Nurse Practitioner | 1547 Commerce Dr, Marshall, MO 65340 | 2017-02-02 |
| 1760877179 | Lifetime Dental Associates | Dentist | 2301 S. 65 Hwy, Suite 1, Marshall, MO 65340 | 2015-04-02 |
| 1780078949 | Glenda Cervantes | Interpreter | 1324 S Ellswort Ave, Marshall, MO 65340 | 2015-03-26 |
| 1174922173 | Michelle Stockman | Licensed Practical Nurse | 1004 S. Lincoln Ave, Marshall, MO 65340 | 2014-08-15 |
| 1730527722 | Lynn C Evans | Pharmacist | 941 S. Cherokee, Suite 1, Marshall, MO 65340 | 2013-06-12 |
| 1740589753 | Bethany Anne Harris | Social Worker | 1126 E. Hwy Ww, Marshall, MO 65340 | 2011-03-17 |
| Find all providers in zip 65340 | ||||
| Taxonomy Code | 251C00000X |
| Grouping | Agencies |
| Classification | Day Training, Developmentally Disabled Services |
| These agencies are authorized to provide day habilitation services to developmentally disabled individuals who live in their homes. The function of day habilitation is to assist an individual to acquire and maintain those life skills that enable the individual to cope more effectively with the demands of independent living. Also to raise the level of the individual's physical, mental, social, and vocational functioning. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003178500 | Rural Enterprise for Acceptable Living, Inc. | Day Training, Developmentally Disabled Services | 109 S 5th St Ste 700, Marshall, MN 56258-1298 | 2012-06-11 |
| 1285891440 | Advance Opportunities | Day Training, Developmentally Disabled Services | 1401 Peterson St, Marshall, MN 56258-2049 | 2008-05-16 |
| 1871627687 | Special Services Learning Center, Inc. | Day Training, Developmentally Disabled Services | 406 Highway 65 S, Marshall, AR 72650-7877 | 2007-03-15 |
| 1992832257 | Bluewest Opportunities, Inc. | Day Training, Developmentally Disabled Services | 317 Kenpak Ln, Marshall, NC 28753-3911 | 2007-02-27 |
| 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 |
| 1902966500 | State of Missouri | Day Training, Developmentally Disabled Services | 504 N Elm St, Marshall, MO 65340 | 2006-12-12 |
| 1518027127 | State of Missouri | Day Training, Developmentally Disabled Services | 1521 S Benton St, Marshall, MO 65340 | 2006-12-12 |
| 1891854550 | State of Missouri | Day Training, Developmentally Disabled Services | 522 W Kay, Marshall, MO 65340 | 2006-12-08 |
| 1356417323 | State of Missouri | Day Training, Developmentally Disabled Services | 320 E Vest St, Marshall, MO 65340-2254 | 2006-11-28 |
| Find all providers in MARSHALL | ||||
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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.