Organization · Type 2 NPI

State of Missouri

Intellectual Disabilities Intermediate Care Facility · St. Charles, MO

NPI number 1992913297 Active

Practice location

22 Marr Ln
St. Charles, MO 63303-9000

Call (636) 926-1300 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.

3 other providers at this address

State of MissouriGeneral Practice Physician St. Charles, MO NPI 1316991896
Amalakumar D. Augustine, MDInternal Medicine Physician St. Charles, MO NPI 1871579896
Karen Joyce Franklin, COTAOccupational Therapy Assistant St. Charles, MO NPI 1275754756

NPI record

NPI: 1992913297
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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ST Charles Habilitation Center · doing business as
ST Charles 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 1992913297

State of Missouri's National Provider Identifier is 1992913297, issued on May 18, 2007. The primary taxonomy on file is Intellectual Disabilities Intermediate Care Facility (315P00000X), and the practice location is in St. Charles, MO. The record was last updated on Aug 26, 2020.