Organization
STATE OF MISSOURI
Active
Parent organization
STATE OF MISSOURI
Other names
St Charles 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
22 MARR LN, SAINT CHARLES, MO 63303-9000
(636) 926-1300
Mailing address
1706 E ELM ST, JEFFERSON CITY, MO 65101-4130
(573) 751-3398
(573) 526-4560
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
052476801
—
MO
Enumeration date
05/18/2007
Last updated
08/26/2020
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