Organization Name: | STATE OF MISSOURI |
NPI Number: | 1942442702 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DANIEL D HAUG (DIR. OF DIV. OF ADMIN. SERVICES) |
Mailing Address: | 11 Brady Cir Saint Louis |
State: | MO US |
Postal Code: | 631141110 |
Phone Number: | 3148771624 |
Fax Number: | 3148775666 |
NPI Enumeration Date: | 03/25/2009 |
NPI Last Update Date: | 11/18/2014 |
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. |