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Glenna Smith
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Newburg, Missouri
NPI 1619091741

Glenna Smith is a Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility based in Newburg, MO. Glenna Smith practices in Newburg, MO. The NPI Number for Glenna Smith is 1619091741 and holds a License No. 5972-9429 (Missouri).

The current practice location address for Glenna Smith is 24752 Clementine Outer Rd, Newburg, MO and can be reached out via phone at 573-762-3201.

Location: 24752 Clementine Outer Rd, Newburg, MO, 65550-0347
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1619091741
Provider Name
Glenna Smith
Credential
Provider Entity Type
Individual
Gender
Female
Address
24752 Clementine Outer Rd, Newburg, MO, 65550-0347
Phone Number
573-762-3201
Fax Number
Provider Enumeration Date
03/16/2007
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
854694106 05 MO
institution
Provider Business Practice Location Address Details
Address
24752 Clementine Outer Rd
City
Newburg
State
Missouri
Zip
65550-9048
Phone Number
573-762-3201
Fax Number
person
Provider Business Mailing Address Details
Address
24752 Clementine Outer Rd
City
Newburg
State
Missouri
Zip
65550-9048
Phone Number
573-762-3201
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.
5972-9429 (Missouri)
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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