Organization
STATE OF MISSOURI
Active
Parent organization
STATE OF MISSOURI
Other names
Northwest MO Psychiatric Rehabilitation Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
STATE OF MISSOURI
Authorized official
MOLLY JANE BOECKMANN (DIRECTOR OF ADMINISTRATIVE SERVICES)
(573) 751-4055
Entity
Organization
Contact information
Practice address
3505 FREDERICK AVE, SAINT JOSEPH, MO 64506-2914
(816) 387-2300
(816) 387-2329
Mailing address
PO BOX 687, JEFFERSON CITY, MO 65102-0687
(573) 751-3398
(573) 526-4560
Taxonomy
Speciality
Code
Description
License number
State
283Q00000X
Psychiatric Hospital
Primary
EXEMPT
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
050157700
—
MO
Enumeration date
05/18/2006
Last updated
10/27/2020
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