Organization · Type 2 NPI

State of Missouri

Intellectual Disabilities Intermediate Care Facility · St. Louis, MO

NPI number 1194933499 Active

Practice location

2312 Lemay Ferry Rd
St. Louis, MO 63125-3127

Call (314) 894-5400 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

Ramarao Kaza, MDUrology Physician St. Louis, MO NPI 1699812990
Valerie Jean Allen Foster, NPGeneral Practice Registered Nurse St. Louis, MO NPI 1649399403

Other intellectual disabilities intermediate care facility providers in St. Louis

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NPI record

NPI: 1194933499
Entity type: Organization (Type 2)
Issued: May 18, 2007
Last updated: Aug 26, 2020
Status: Active
Subpart: Yes of State of Missouri

Other names

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South County Habilitation Center · doing business as
South County 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 1194933499

State of Missouri's National Provider Identifier is 1194933499, issued on May 18, 2007. The primary taxonomy on file is Intellectual Disabilities Intermediate Care Facility (315P00000X), and the practice location is in St. Louis, MO. The record was last updated on Aug 26, 2020.