Organization
STATE OF MISSOURI
Active
Parent organization
STATE OF MISSOURI
Other names
Bellefontaine Habilitaion Center-Waiver Services
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
10695 BELLEFONTAINE RD, SAINT LOUIS, MO 63137-2315
(314) 340-6000
(314) 340-6199
Mailing address
1706 E. ELM ST., 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
—
—
Other
Enumeration date
09/23/2011
Last updated
10/27/2020
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