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Southeast Missouri State University
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Cape Girardeau, Missouri
NPI 1295014470

Southeast Missouri State University is a Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility based in Cape Girardeau, MO. Southeast Missouri State University practices in Cape Girardeau, MO. The NPI Number for Southeast Missouri State University is 1295014470 and holds a License No. (Missouri).

The current practice location address for Southeast Missouri State University is 2100 Themis St Ste 103C, Cape Girardeau, MO and can be reached out via phone at 573-290-5115 and via fax at 573-290-5142.

Location: 2100 Themis St Ste 103C, Cape Girardeau, MO, 63701-5124
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1295014470
Provider Name
Southeast Missouri State University
Credential
Provider Entity Type
Organization
Address
2100 Themis St Ste 103C, Cape Girardeau, MO, 63701-5124
Phone Number
573-290-5115
Fax Number
573-290-5142
Provider Enumeration Date
08/05/2011
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
1780753640 05 MO
institution
Provider Business Practice Location Address Details
Address
2100 Themis St Ste 103C
City
Cape Girardeau
State
Missouri
Zip
63701-5124
Phone Number
573-290-5115
Fax Number
573-290-5142
person
Provider Business Mailing Address Details
Address
2100 Themis St Ste 103C
City
Cape Girardeau
State
Missouri
Zip
63701-5124
Phone Number
573-290-5115
Fax Number
573-290-5142
person
Provider's Taxonomy Details 1
Type
Residential Treatment Facilities
Classification
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Speciality
-
Taxonomy
320900000X
License No.
()
Definition
A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with intellectual and/or developmental disabilities.
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