JEFFERSON CITY RESIDENTIAL, LLC
NPI 1164792917
Alzheimer Center (Dementia Center) in Jefferson City, MO
NPI Status: Active since January 11, 2012
Contact Information
3409 N TEN MILE DR
JEFFERSON CITY, MO
ZIP 65109
Phone: (573) 471-1113
- Organization
- Alzheimer Center (Dementia Center)
- CLIA Number: 26D2097671
- CLIA Cert. Type: Assisted Living Facility
- CLIA Exp. Date: 06-21-2027
About JEFFERSON CITY RESIDENTIAL, LLC
This page provides the complete NPI Profile along with additional information for Jefferson City Residential, Llc, a provider established in Jefferson City, Missouri operating as a Alzheimer Center (dementia Center). The healthcare provider is registered in the NPI registry with number 1164792917 assigned on January 2012. The practitioner's primary taxonomy code is 311500000X. The provider is registered as an organization and their NPI record was last updated February 2026. The provider's
- NPI
- 1164792917
- Provider Legal Name
- JEFFERSON CITY RESIDENTIAL, LLC
- Other Organization Name
- Other Name Type
- (6)
- Entity Type
- Organization
- Location Address
- 3409 N TEN MILE DR JEFFERSON CITY, MO 65109
- Location Phone
- (573) 471-1113
- Mailing Address
- 3409 N TEN MILE DR JEFFERSON CITY, MO 65109
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 01-11-2012
- Last Update Date
- 02-02-2026
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Alzheimer Center (Dementia Center)
- Taxonomy Code
- 311500000X
- Type
- Nursing & Custodial Care Facilities
- Taxonomy Description
- A freestanding facility or special care unit of a long term care facility focusing on patient care of individuals diagnosed with dementia or Alzheimer's Disease or their related diseases. Six elements of the facility/unit set it apart from other (the rest of the) facilities(y): Admission of residents with dementia (including those with Alzheimer's disease); Staff who are specially selected, trained, and supervised; Activities that are specifically designed for the cognitively impaired; A marketing of a special care unit in brochures; A high level of family involvement; and A physical environment designed to keep residents safe and segregated from other populations.
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 26D2097671
- Facility Type
- Assisted Living Facility
- Certificate Effective Date
- June 22, 2025
- Certificate Expiration Date
- June 21, 2027
- Laboratory Director
- CAROLINA HALL-DIEDERICH
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Jefferson City Residential, Llc to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1164792917, we treat the final digit (7) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 63. The final step is to find the difference between that total and the next multiple of ten (70 - 63 = 7).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 63 is 70. The difference is the calculated check digit.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1164792917, enumerated as an "organization" on January 11, 2012.
The provider is located at 3409 N TEN MILE DR JEFFERSON CITY, MO 65109 and the phone number is (573) 471-1113.
Alzheimer Center (Dementia Center) with taxonomy code 311500000X.
