Organization · Type 2 NPI

State of Missouri

Intellectual Disabilities Intermediate Care Facility · Overland, MO

NPI number 1164630463 Active

Practice location

11 Brady Cir
Overland, MO 63114-1110

Call (314) 428-8470 Map

Mailing address

1706 E Elm St
Jefferson City, MO 65101-4130

Specialties and licenses

Taxonomy	Code	License
Intellectual Disabilities Intermediate Care Facility Primary	315P00000X	None listed

Intellectual Disabilities Intermediate Care Facility: An intermediate care facility providing services for individuals with intellectual disabilities.

2 other providers at this address

State of MissouriIntellectual and/or Developmental Disabilities Residential Treatment Facility St. Louis, MO NPI 1326372301
State of MissouriIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility St. Louis, MO NPI 1942442702

NPI record

NPI: 1164630463
Entity type: Organization (Type 2)
Issued: May 18, 2007
Last updated: Oct 27, 2020
Status: Active
Subpart: Yes of State of Missouri

Other names

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North West Habilitation Center · doing business as
North West Habilitation Center · doing business as

Authorized official

Molly Jane Boeckmann
Director of Administrative Services
(573) 751-4055

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1164630463

State of Missouri's National Provider Identifier is 1164630463, issued on May 18, 2007. The primary taxonomy on file is Intellectual Disabilities Intermediate Care Facility (315P00000X), and the practice location is in Overland, MO. The record was last updated on Oct 27, 2020.