STATE OF MISSOURI (NPI# 1942442702) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1942442702 |
| Entity Type | Organization |
| Organization Name | STATE OF MISSOURI |
| Other Organization Name | ST. LOUIS DEVELOPMENTAL DISABILITIES TREATMENT CENTER ISL |
| Practice Address |
11 Brady Cir Saint Louis MO 63114-1110 |
| Mailing Address |
1706 E Elm St Jefferson City MO 65101-4130 |
| Practice Telephone | 3148771624 |
| Practice Fax Number | 3148775666 |
| Mailing Telephone | 5737513398 |
| Mailing Fax Number | 5735264560 |
| Enumeration Date | 2009-03-25 |
| 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 |
|---|---|
| St. Louis Developmental Disabilities Treatment 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 |
11 BRADY CIR |
| City | SAINT LOUIS |
| State | MO |
| Zip Code | 63114-1110 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326372301 | State of Missouri | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 11 Brady Cir, 2, Saint Louis, MO 63114-1110 | 2009-09-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053926964 | Deann Porter | Prosthetist | 8743 Mavis Place, St Louis, MO 63114 | 2020-09-09 |
| 1255971438 | Hughes In Home Services | Home Health | 9319 Midland Ste B, St Louis, MO 63114 | 2020-01-15 |
| 1740714724 | Catherine Kagotho | Nurse Practitioner | 9915 Broadmoor Dr, Apt 4, Overland, MO 63114 | 2017-04-17 |
| 1073051371 | Ruth & Naomi Adult Day Services, Inc | Clinic/Center | 9443-9445 Lackland Road, St. Louis, MO 63114 | 2017-02-07 |
| 1992103691 | Lisa Abernathy | Social Worker | 9705 Tennyson Court, Saint Louis, MO 63114 | 2014-12-11 |
| 1356626808 | William J Norbury | Pharmacist | 8000 St. Charles Rock Road, Walgreens Pharmacy 4825, St.louis, MO 63114 | 2011-10-17 |
| 1770719700 | Total Renal Care Inc | Clinic/Center | 9030 Saint Charles Rock Rd, Saint Louis, MO 63114 | 2009-06-04 |
| 1710126792 | Risingabove Independent Supported Living | Assisted Living Facility | 2330 # 2 Woodson Road, Overland, MO 63114 | 2009-02-13 |
| 1427215789 | Wnf Medical, LLC | Durable Medical Equipment & Medical Supplies | 1908-2000 Innerhelt Business Center Dr., Suite 1968, Overland, MO 63114 | 2008-05-22 |
| 1891838744 | Easter Seals Midwest | Day Training, Developmentally Disabled Services | 2215 Lackland Road, Overland, MO 63114 | 2007-02-14 |
| Find all providers in zip 63114 | ||||
| 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 |
|---|---|---|---|---|
| 1588108336 | Wright Way Residential Living | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 2115 Allen Ave, Apt A, Saint Louis, MO 63104-2630 | 2016-12-13 |
| 1952768889 | Living With Purpose | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 3919 N 19th St, Saint Louis, MO 63107-2816 | 2016-01-22 |
| 1154788156 | Promise Mobility LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 5 S Newstead Ave, Saint Louis, MO 63108-2213 | 2016-01-21 |
| 1013334622 | Ebony Wilson | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 3514 Blair Ave, Saint Louis, MO 63107-3717 | 2014-03-20 |
| 1871914515 | Donald Scales | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 8543 Jane Ave, Saint Louis, MO 63121-4309 | 2013-12-24 |
| 1609218593 | Young Mens Christian Association of Greater St Louis | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1528 Locust St, Saint Louis, MO 63103-1816 | 2013-07-22 |
| 1467894535 | Sun Valley Adult Care Center, Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1000 Saint Cyr Rd, Saint Louis, MO 63137-1733 | 2013-07-18 |
| 1477802957 | Phillips Professional Home Health Service | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 8456 A Page Ave, Saint Louis, MO 63130-1055 | 2012-08-30 |
| 1013283373 | Mers/missouri Goodwill Industries | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1727 Locust St, Saint Louis, MO 63103-1703 | 2012-03-30 |
| 1720359961 | Bethesda Lutheran Communities Inc | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 5122 Amberglow Dr, Saint Louis, MO 63129-3204 | 2012-01-19 |
| Find all providers in SAINT LOUIS | ||||
| City | SAINT LOUIS |
| Zip Code | 63114 |
Please comment or provide details below to improve the information on STATE OF MISSOURI.
| 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.