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STATE OF MISSOURI

Intermediate Care Facility, Mentally Retarded

Nevada, Missouri

Provider NPI: 1376614701

Organization Information:
Organization Name:  STATE OF MISSOURI


Practice Location:
2323 N ASH ST  NEVADA, MO 64772 US
Tel: 417-667-7833  Fax: --

Business Mailing Address:
  ,   
Tel: --  Fax: --


Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y315P00000XNursing & Custodial Care Facilities
Intermediate Care Facility, Mentally Retarded
MOEXEMPT

Other Provider Identifiers:

IssuerNumberStateType
051499903MO05
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin




MENTALLY RETARDED JOBS MO - Page 1



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