Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days.
Organization
CLARK SUPPORTED LIVING
Active
Organization
CLARK SUPPORTED LIVING
Active
Other names
CSL Missouri
Organization subpart
No
Provider details
NPI number
Authorized official
ZONDRA D CLARK RN (EXECUTIVE DIRECTOR)
(773) 332-6106
Entity
Organization
Contact information
Practice address
303 MACAW DR, COLUMBIA, MO 65202
(773) 332-6106
Mailing address
303 MACAW DR, COLUMBIA, MO 65202-6284
(773) 332-6106
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
—
NULL
163WC1500X
Community Health Registered Nurse
—
—
174200000X
Meals Provider
—
NULL
251B00000X
Case Management Agency
—
NULL
251J00000X
Nursing Care Agency
—
NULL
251S00000X
Community/Behavioral Health Agency
—
NULL
251X00000X
Supports Brokerage Agency
—
NULL
253Z00000X
In Home Supportive Care Agency
—
NULL
261QA0600X
Adult Day Care Clinic/Center
—
NULL
261QD1600X
Developmental Disabilities Clinic/Center
—
NULL
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
NULL
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
NULL
385H00000X
Respite Care
—
NULL
385HR2055X
Child Mental Illness Respite Care
—
NULL
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
NULL
385HR2065X
Child Physical Disabilities Respite Care
—
NULL
Other
Enumeration date
10/17/2018
Last updated
10/17/2018
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign upProduct
Developers