Organization
STATE OF MISSOURI
Active
Parent organization
STATE OF MISSOURI
Other names
Marshall Habilitation Center-Home 5
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
1503 S GRANT AVE, MARSHALL, MO 65340-2922
(660) 886-2201
(660) 831-3071
Mailing address
1706 E ELM ST, JEFFERSON CITY, MO 65101-4130
(573) 751-3398
(573) 526-4560
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
EXEMPT
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
853529501
—
MO
Enumeration date
11/28/2006
Last updated
10/20/2020
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