State of Missouri
State of Missouri is an Intellectual Disabilities Intermediate Care Facility in Saint Louis, Missouri. Registered with an NPI since 2011.
- In the registry since
- 2011
Practice location Address checks out
10695 Bellefontaine RdSaint Louis, MO 63137-2315
Phone: (314) 340-6000
Fax: (314) 340-6199
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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 |
|---|
Record details
| NPI number | 1770866030 |
|---|---|
| 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 | Bellefontaine Habilitaion Center-Waiver Services; Bellefontaine Habilitaion Center-Waiver Services |
| NPI enumerated | September 23, 2011 |
| Last updated in NPPES | October 27, 2020 |
| Certification date | October 27, 2020 |
| Mailing address | 1706 E. Elm St., Po Box 687, Jefferson City, MO 65102-0687 |
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State of Missouri
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State of Missouri
10695 Bellefontaine Rd, Saint Louis, MO 63137-2315 · (314) 340-6000