Organization · Type 2 NPI

State of Missouri

Intellectual Disabilities Intermediate Care Facility · Sikeston, MO

NPI number 1598844029 Active

Practice location

112 Plaza Dr
Sikeston, MO 63801-5137

Call (573) 472-5300 Map

Fax (573) 472-5308

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 MissouriDevelopmentally Disabled Services Day Training Agency Sikeston, MO NPI 1043386014
State of MissouriCase Management Agency Sikeston, MO NPI 1316017056
State of MissouriFamily Medicine Physician Sikeston, MO NPI 1528348430
Miles C. Reece Iii, DOEmergency Medicine Physician Sikeston, MO NPI 1457486870

NPI record

NPI: 1598844029
Entity type: Organization (Type 2)
Issued: Nov 3, 2006
Last updated: Oct 27, 2020
Status: Active
Subpart: Yes of State of Missouri

Other names

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Southeast Missouri Residential Services-Sikeston · doing business as
Southeast Missouri Residential Services-Sikeston · 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 1598844029

State of Missouri's National Provider Identifier is 1598844029, issued on Nov 3, 2006. The primary taxonomy on file is Intellectual Disabilities Intermediate Care Facility (315P00000X), and the practice location is in Sikeston, MO. The record was last updated on Oct 27, 2020.