State of Missouri

Organization Intellectual Disabilities Intermediate Care Facility · NPI 1124198981

State of Missouri is an Intellectual Disabilities Intermediate Care Facility in Poplar Bluff, Missouri. Licensed in Missouri. Registered with an NPI since 2006.

Licensed in: MO
In the registry since: 2006

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Practice location Address checks out

2351 Kanell Blvd
Poplar Bluff, MO 63901-4035
Phone: (573) 840-9370
Fax: (573) 840-9373

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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Intellectual Disabilities Intermediate Care Facility (primary)	Taxonomy 315P00000X · Licence EXEMPT (MO)

Record details

NPI number	1124198981
Entity type	Organization (Type 2)
Organization subpart	Yes
Parent organization	State of Missouri
Authorized official	Molly Boeckmann — Director Of Administrative Services · (573) 751-4055
Other names	Southeast Missouri Residential Services-Poplar Bluff; Southeast Missouri Residential Services-Poplar Bluff
NPI enumerated	November 9, 2006
Last updated in NPPES	October 27, 2020
Certification date	October 27, 2020
Mailing address	Po Box 687, Jefferson City, MO 65102-0687