GIBSON RECOVERY CENTER, INC. (NPI# 1184774275) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1184774275 |
| Entity Type | Organization |
| Organization Name | GIBSON RECOVERY CENTER, INC. |
| Practice Address |
1112 Linden St Cape Girardeau MO 63703-7707 |
| Mailing Address |
Po Box 1267 Cape Girardeau MO 63702-1267 |
| Practice Telephone | 5733320416 |
| Practice Fax Number | 5733340312 |
| Mailing Telephone | 5733320416 |
| Mailing Fax Number | 5733340312 |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2008-04-23 |
| Authorized Official Name | MR. JOHN H GARY (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 5733320416 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 324500000X | Substance Abuse Rehabilitation Facility | 30567335 | MO | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | BLUE CROSSBLUE SHIELD | 105152 | 01 |
| MO | 863112702 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679928501 | Gibson Recovery Center, Inc. | Clinic/Center | 340 S Broadview St, Cape Girardeau, MO 63703-5703 | 2016-04-28 |
| 1164719373 | Gibson Recovery Center, Inc. | Counselor | 340 S Broadview St, Cape Girardeau, MO 63703-5703 | 2011-07-08 |
| Street Address |
1112 LINDEN ST |
| City | CAPE GIRARDEAU |
| State | MO |
| Zip Code | 63703-7707 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447734207 | Wendy Hughes | Licensed Practical Nurse | 1112 Linden St, Cape Girardeau, MO 63703-7707 | 2018-09-18 |
| 1710470794 | April Cain | Licensed Practical Nurse | 1112 Linden St, Cape Girardeau, MO 63703-7707 | 2018-06-13 |
| 1114428802 | Morgan Dawson | Licensed Practical Nurse | 1112 Linden St, Cape Girardeau, MO 63703-7707 | 2018-02-27 |
| 1306345954 | Casey Holzum | Licensed Practical Nurse | 1112 Linden St, Cape Girardeau, MO 63703-7707 | 2018-02-09 |
| 1679071013 | Sherri Mallory | Licensed Practical Nurse | 1112 Linden St, Cape Girardeau, MO 63703-7707 | 2018-01-31 |
| 1154829596 | Mary Hill | Registered Nurse | 1112 Linden St, Cape Girardeau, MO 63703-7707 | 2018-01-31 |
| 1629576111 | Hannah Cox | Licensed Practical Nurse | 1112 Linden St, Cape Girardeau, MO 63703-7707 | 2018-01-30 |
| 1336647833 | Macy Tatum | Licensed Practical Nurse | 1112 Linden St, Cape Girardeau, MO 63703-7707 | 2018-01-30 |
| 1215435706 | Miranda Landreth | Licensed Practical Nurse | 1112 Linden St, Cape Girardeau, MO 63703-7707 | 2018-01-30 |
| 1295243384 | Brittany James | Registered Nurse | 1112 Linden St, Cape Girardeau, MO 63703-7707 | 2018-01-11 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720566102 | Christian Torres Diaz | Dentist | 3070 William Street, Cape Girardeau, MO 63703 | 2018-07-30 |
| 1457758153 | Broadway Ltc, LLC | Pharmacy | 37 Doctors Park Ste 7, Cape Girardeau, MO 63703 | 2014-11-24 |
| 1336562263 | Rachel Speer | Community Health Worker | 20 South Sprigg St, Cape Girardeau, MO 63703 | 2014-01-29 |
| 1245653120 | Mary Wilburn | Community Health Worker | 20 S Spigg, Cape Girardeau, MO 63703 | 2014-01-28 |
| 1831523695 | Saint Francis Medical Center | General Acute Care Hospital | 150 South Mount Auburn Road, Suite 342, Cape Girardeau, MO 63703 | 2013-08-29 |
| 1033481163 | J K Essmyer Medical Services LLC | Clinic/Center | 300 Mt Auburn Rd, Auburn Surgery Center, Inc, Cape Girardeau, MO 63703 | 2012-02-06 |
| 1477867844 | Drx - East Missouri Providers, P.C. | Family Medicine | 465 S Mount Auburn Road, Suite 103, Cape Girardeau, MO 63703 | 2010-07-28 |
| 1346564879 | Richard William Tobey | Family Medicine | 3250 Gordonville Rd Ste 301, Cape Girardeau, MO 63703 | 2010-03-26 |
| 1144413568 | Stephanie Danette Miller | Family Medicine | 817 S. Mount Auburn, Suite 100, Southeast Primary Care, Cape Gerardeau, MO 63703 | 2007-08-20 |
| 1437349305 | Shanaree Mae Muzinich | Radiology | 70 Doctor's Park, Cape Girardeau, MO 63703 | 2007-07-27 |
| Find all providers in zip 63703 | ||||
| Taxonomy Code | 324500000X |
| Grouping | Residential Treatment Facilities |
| Classification | Substance Abuse Rehabilitation Facility |
| A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. |
| Notes: [7/1/2003: modified title, modified definition] |
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|---|---|---|---|---|
| 1073112967 | Hurdler Outreach Services LLC | Substance Abuse Rehabilitation Facility | 6425 Evanston Ave, Raytown, MO 64133-4931 | 2020-10-21 |
| 1912529041 | Ip Reserve | Substance Abuse Rehabilitation Facility | 21708 Nickel Ave, Gallatin, MO 64640-6369 | 2020-05-12 |
| 1417577107 | Sana Lake Recovery Center, LLC | Substance Abuse Rehabilitation Facility | 150 Sana Lake Recovery Way, Dittmer, MO 63023 | 2020-04-22 |
| 1639723463 | Haven Recovery Homes | Substance Abuse Rehabilitation Facility | 3929 Michigan Ave, Saint Louis, MO 63118-4324 | 2019-07-30 |
| 1356875678 | Summit Bhc Saint Louis, LLC | Substance Abuse Rehabilitation Facility | 22933 Hwy 61, Eolia, MO 63344 | 2017-04-13 |
| 1821549122 | Preferred Family Healthcare, Inc | Substance Abuse Rehabilitation Facility | 2415 W Catalpa St, Springfield, MO 65807-1123 | 2016-10-21 |
| 1225496052 | Betty Lou Wallace Recovery LLC | Substance Abuse Rehabilitation Facility | 13350 Holmes Rd, Kansas City, MO 64145-1437 | 2016-02-08 |
| 1326414350 | Synergy Recovery Center | Substance Abuse Rehabilitation Facility | 3955 S Farm Road 223, Rogersville, MO 65742-8807 | 2015-08-13 |
| 1821406174 | Preferred Family Healthcare, Inc | Substance Abuse Rehabilitation Facility | 4066 Dunnica, Saint Louis, MO 63118 | 2014-07-31 |
| 1932517653 | Summit Bhc Lafayette LLC | Substance Abuse Rehabilitation Facility | 551 Warren Ave, Saint Louis, MO 63130-4155 | 2014-07-25 |
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| City | CAPE GIRARDEAU |
| Zip Code | 63703 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.