# NICKLES PRIVATE PROBATION SERVICES LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215779665
- **Authorized official:** MR. KENNETH LEE NICKLES JR. (SOLE MEMBER)
- **Authorized official phone:** (573) 712-5145

## Contact information

- **Practice address:** 205 3RD ST, STEELVILLE, MO 65565-5054
- **Practice address phone:** (573) 712-5145
- **Practice address fax:** (630) 305-9287
- **Mailing address:** PO BOX 1325, STEELVILLE, MO 65565-1325
- **Mailing address phone:** (573) 712-5145
- **Mailing address fax:** (630) 604-9287

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR0800X | Recovery Care Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 06/07/2024
- **Last updated:** 06/07/2024