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State Of Missouri
Intellectual Disabilities Intermediate Care Facility in Poplar Bluff, Missouri
NPI 1124198981

State Of Missouri is a Intellectual Disabilities Intermediate Care Facility based in Jefferson City, MO. State Of Missouri practices in Poplar Bluff, MO. The NPI Number for State Of Missouri is 1124198981 and holds a License No. EXEMPT (Missouri).

The current practice location address for State Of Missouri is 2351 Kanell Blvd, Poplar Bluff, MO and can be reached out via phone at 573-840-9370 and via fax at 573-840-9373.

Location: 2351 Kanell Blvd, Poplar Bluff, MO, 65102-0687
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1124198981
Provider Name
State Of Missouri
Credential
Provider Entity Type
Organization
Address
2351 Kanell Blvd, Poplar Bluff, MO, 65102-0687
Phone Number
573-840-9370
Fax Number
573-840-9373
Provider Enumeration Date
11/09/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
051793107 05 MO
institution
Provider Business Practice Location Address Details
Address
2351 Kanell Blvd
City
Poplar Bluff
State
Missouri
Zip
63901-4035
Phone Number
573-840-9370
Fax Number
573-840-9373
person
Provider Business Mailing Address Details
Address
2351 Kanell Blvd
City
Poplar Bluff
State
Missouri
Zip
63901-4035
Phone Number
573-840-9370
Fax Number
573-840-9373
person
Provider's Taxonomy Details 1
Type
Nursing & Custodial Care Facilities
Classification
Intermediate Care Facility, Mentally Retarded
Speciality
-
Taxonomy
315P00000X
License No.
EXEMPT (Missouri)
Definition
(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.
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