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SOUTHEAST MISSOURI RESIDENTIAL SERVICES
NPI 1568601482
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities in Poplar Bluff, MO

Active since February 17, 2009
2351 KANELL BLVD, POPLAR BLUFF, MO 63901(573) 840-9300(573) 840-9373 Get Directions Write a Review

NPPES record last updated: October 15, 2020. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Southeast Missouri Residential Services NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUTHEAST MISSOURI RESIDENTIAL SERVICES (NPI 1568601482) is a healthcare organization registered as a community based residential treatment facility, intellectual and/or developmental disabilities in Poplar Bluff, Missouri and active in the NPI registry since February 2009. The organization lists Molly Jane Boeckmann, Director Of Administrative Services, as its authorized official.

NPPES Registry Identity

NPI1568601482
Entity TypeOrganization
Primary Taxonomy320900000X
Legal Business NameSOUTHEAST MISSOURI RESIDENTIAL SERVICES
Location Address2351 KANELL BLVDPoplar Bluff, MO 63901-4035
Mailing Address2351 Kanell BlvdPoplar Bluff, MO 63901-4035 · (573) 840-9300 · Fax (573) 840-9373
Phone(573) 840-9300
Fax(573) 840-9373
Organization SubpartNo
Authorized OfficialMolly Jane BoeckmannDirector Of Administrative Services · (573) 751-4055
Enumeration DateFebruary 17, 2009
Last NPPES UpdateOctober 15, 2020
NPPES CertifiedOctober 15, 2020
✔ NPI 1568601482 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCommunity Based Residential Treatment Facility, Intellectual and/or Developmental DisabilitiesResidential Treatment Facilities
Taxonomy Code320900000X
Definition
A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities.
2351 KANELL BLVD, Poplar Bluff, MO 63901
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Other Identifiers 1

Medicaid856407804MO

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

STATE OF MISSOURI
Case Management
2351 KANELL BLVD
POPLAR BLUFF, MO 63901
Butler County (573) 840-9300
STATE OF MISSOURI
Intermediate Care Facility, Intellectual Disabilities
2351 KANELL BLVD
POPLAR BLUFF, MO 63901
Butler County (573) 840-9370
STATE OF MISSOURI
Day Training, Developmentally Disabled Services
2351 KANELL BLVD
POPLAR BLUFF, MO 63901
Butler County (573) 840-9300
STATE OF MISSOURI
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
2351 KANELL BLVD
POPLAR BLUFF, MO 63901
Butler County (573) 840-9374
STATE OF MISSOURI
Family Medicine
2351 KANELL BLVD
POPLAR BLUFF, MO 63901
Butler County (573) 840-9370

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Southeast Missouri Residential Services's NPI number?

The NPI number for Southeast Missouri Residential Services is 1568601482. It was assigned to this organization in the NPPES registry on February 17, 2009.

Where is Southeast Missouri Residential Services located?

Southeast Missouri Residential Services is located at 2351 Kanell Blvd, Poplar Bluff, MO 63901. The listed phone number is (573) 840-9300.

What is Southeast Missouri Residential Services's specialty?

The primary specialty registered for this NPI is Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities with taxonomy code 320900000X.

When was this NPI record last updated?

The NPPES record for Southeast Missouri Residential Services was last updated on October 15, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.