Organization
BOYS & GIRLS TOWN OF MISSOURI
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANNE TUCKER (RESIDENT DIRECTOR)
(417) 865-1646
Entity
Organization
Contact information
Practice address
1212 W LOMBARD ST, SPRINGFIELD, MO 65806-2720
(417) 865-1646
(417) 866-1483
Mailing address
4696 N FARM ROAD 129, SPRINGFIELD, MO 65803-6229
(417) 425-6273
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
2001021788
MO
Other
Enumeration date
11/06/2006
Last updated
08/22/2020
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