Organization Name: | STATE OF MISSOURI |
NPI Number: | 1760681415 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | BRENT MCGINTY (DMH DIRECTOR OF ADMINISTRATION) |
Mailing Address: | 1501 N River Blvd Independence |
State: | MO US |
Postal Code: | 640501760 |
Phone Number: | 8165127515 |
Fax Number: | 8165127517 |
NPI Enumeration Date: | 07/13/2007 |
NPI Last Update Date: | 12/15/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 320900000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Residential Treatment Facilities |
Taxonomy Classification: | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
Taxonomy Specialization: | |
Taxonomy Definition: | A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. |