STATE OF MISSOURI NPI 1386843621

NPI Information

  • NPI: 1386843621
  • Provider Name: STATE OF MISSOURI
  • Classification: Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities - 320900000X
  • Entity Type: Organization
  • Doing Business As: LAKELAND GROUP HOME
  • Address: 15555 LITTLE BLUE RD
    KANSAS CITY, MO
    ZIP 64139
  • Phone: (816) 512-7515

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NPI Details

STATE OF MISSOURI is a community based residential treatment facility, intellectual and/or developmental disabilities in Kansas City, MO. The provider is a home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. STATE OF MISSOURI NPI is 1386843621. The provider is registered as an organization entity type.
The provider Is Doing Business As Lakeland Group Home.

The provider's business location address is:

15555 LITTLE BLUE RD
KANSAS CITY, MO
ZIP 64139
Phone: (816) 512-7515
Fax: (816) 512-7517

The provider's authorized official is Molly Jane Boeckmann .
The authorized official title is Director Of Administrative Services and has the following contact phone number (573) 751-4055.

The enumeration date for this NPI number is 7/17/2007 and was last updated on 8/28/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1320900000XCommunity Based Residential Treatment Facility, Intellectual and/or Developmental DisabilitiesYes

What is NPI?

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This page was last updated on: 3/30/2025

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