Organization · Type 2 NPI

State of Missouri

Intellectual Disabilities Intermediate Care Facility · Nevada, MO

NPI number 1376614701 Active

Practice location

2323 N Ash St
Nevada, MO 64772-1054

Call (417) 667-7833 Map

Fax (417) 448-1138

Mailing address

PO Box 687
Jefferson City, MO 65102-0687

Specialties and licenses

Taxonomy	Code	License
Intellectual Disabilities Intermediate Care Facility Primary	315P00000X	EXEMPT (MO)

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

4 other providers at this address

State of MissouriGeneral Practice Physician Nevada, MO NPI 1114971702
State of MissouriIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility Nevada, MO NPI 1811137516
Inn T. Park, MDIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility Nevada, MO NPI 1588713853
Lewis Shilane, DOFamily Medicine Physician Nevada, MO NPI 1013940469

NPI record

NPI: 1376614701
Entity type: Organization (Type 2)
Issued: Nov 9, 2006
Last updated: Sep 3, 2020
Status: Active
Subpart: Yes of State of Missouri

Other names

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Nevada Habilitation Center · doing business as
Nevada 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 1376614701

State of Missouri's National Provider Identifier is 1376614701, issued on Nov 9, 2006. The primary taxonomy on file is Intellectual Disabilities Intermediate Care Facility (315P00000X), and the practice location is in Nevada, MO. The record was last updated on Sep 3, 2020.