STATE OF MISSOURI (NPI# 1811137516) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811137516 |
| Entity Type | Organization |
| Organization Name | STATE OF MISSOURI |
| Other Organization Name | NEVADA HABILITATION CENTER ISL |
| Practice Address |
2323 N Ash St Nevada MO 64772-1054 |
| Mailing Address |
1706 E Elm St Jefferson City MO 65101-4130 |
| Practice Telephone | 4176677833 |
| Practice Fax Number | 4174481146 |
| Mailing Telephone | 5737513398 |
| Mailing Fax Number | 5735264560 |
| Enumeration Date | 2009-02-20 |
| Last Update Date | 2020-08-28 |
| 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 | 320900000X | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | Residential Treatment Facilities |
| Other Name | Type Code |
|---|---|
| Nevada Habilitation Center ISL | 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 |
| 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 |
| 1376614701 | State of Missouri | Intermediate Care Facility, Mentally Retarded | 2323 N Ash St, Nevada, MO 64772-1054 | 2006-11-09 |
| 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 | 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 |
|---|---|---|---|---|
| 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 |
| 1205951217 | Skills Unlimited, Inc | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1428 W Walnut St, Nevada, MO 64772-1966 | 2007-03-20 |
| 1801852538 | Wilkinson Pharmacy, Inc | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 105 S Oak, Nevada, MO 64772-3436 | 2006-04-21 |
| 1902284755 | Preferred Family Healthcare | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 429 E Walnut St, Nevada, MO 64772-2457 | 2015-05-13 |
| 1346365343 | Skills Unlimited Inc | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 2000 N Elm St, Nevada, MO 64772-1073 | 2007-03-20 |
| 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 |
| 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.