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State Of Missouri
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Poplar Bluff, Missouri
NPI 1598906372

State Of Missouri is a Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility based in Jefferson City, MO. State Of Missouri practices in Poplar Bluff, MO. The NPI Number for State Of Missouri is 1598906372 and holds a License No. (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 573-840-9374.

Location: 2351 Kanell Blvd, Poplar Bluff, MO, 65101-4130
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1598906372
Provider Name
State Of Missouri
Credential
Provider Entity Type
Organization
Address
2351 Kanell Blvd, Poplar Bluff, MO, 65101-4130
Phone Number
573-840-9374
Fax Number
Provider Enumeration Date
03/09/2009
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
2351 Kanell Blvd
City
Poplar Bluff
State
Missouri
Zip
63901-4035
Phone Number
573-840-9374
Fax Number
person
Provider Business Mailing Address Details
Address
2351 Kanell Blvd
City
Poplar Bluff
State
Missouri
Zip
63901-4035
Phone Number
573-840-9374
Fax Number
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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