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Organization

STATE OF MISSOURI

Active
Parent organization
STATE OF MISSOURI
Other names
Higginsville Habilitation 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
100 W 1ST ST, HIGGINSVILLE, MO 64037-1171
(660) 584-2142
(660) 584-6244
Mailing address
PO BOX 687, JEFFERSON CITY, MO 65102-0687
(573) 751-3398
(573) 526-4560

Taxonomy

Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
EXEMPT
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
051499705
MO
Enumeration date
11/09/2006
Last updated
10/27/2020
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