CLARK SUPPORTED LIVING (NPI# 1326514381) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1326514381 |
| Entity Type | Organization |
| Organization Name | CLARK SUPPORTED LIVING |
| Practice Address |
303 Macaw Dr Columbia MO 65202 |
| Mailing Address |
303 Macaw Dr Columbia MO 65202-6284 |
| Practice Telephone | 7733326106 |
| Mailing Telephone | 7733326106 |
| Enumeration Date | 2018-10-17 |
| Last Update Date | 2018-10-17 |
| Authorized Official Name | ZONDRA D CLARK (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 7733326106 |
| Authorized Official Credential | RN |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163WC1500X |
Registered Nurse Specialization: Community Health |
Nursing Service Providers | ||
| N | 174200000X | Meals | Other Service Providers | ||
| N | 251B00000X | Case Management | Agencies | ||
| N | 251J00000X | Nursing Care | Agencies | ||
| N | 251S00000X | Community/Behavioral Health | Agencies | ||
| N | 251X00000X | Supports Brokerage | Agencies | ||
| N | 253Z00000X | In Home Supportive Care | Agencies | ||
| N | 261QA0600X |
Clinic/Center Specialization: Adult Day Care |
Ambulatory Health Care Facilities | ||
| N | 261QD1600X |
Clinic/Center Specialization: Developmental Disabilities |
Ambulatory Health Care Facilities | ||
| N | 320900000X | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | Residential Treatment Facilities | ||
| N | 385H00000X | Respite Care | Respite Care Facility | ||
| N | 385HR2055X |
Respite Care Specialization: Respite Care, Mental Illness, Child |
Respite Care Facility | ||
| N | 385HR2060X |
Respite Care Specialization: Respite Care, Mental Retardation and/or Developmental Disabilities, Child |
Respite Care Facility | ||
| N | 385HR2065X |
Respite Care Specialization: Respite Care, Physical Disabilities, Child |
Respite Care Facility | ||
| Y | 320600000X | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | Residential Treatment Facilities |
| Other Name | Type Code |
|---|---|
| CSL Missouri | Other Name - Individual/Organization |
| Street Address |
303 MACAW DR |
| City | COLUMBIA |
| State | MO |
| Zip Code | 65202 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699374629 | Curators of The University of Missouri | Pharmacy | 7115 East St. Charles Road, Columbia, MO 65202 | 2020-10-21 |
| 1245871540 | Ranshell Micole Harrington | Registered Nurse | 7455 Noah Court Columbia, Mo65202, Columbia, MO 65202 | 2019-10-08 |
| 1851873608 | Phoenix Programs, Inc. | Counselor | 90 E. Leslie Ln., Columbia, MO 65202 | 2018-08-29 |
| 1760973044 | Centerpointe Hospital of Columbia, LLC | Psychiatric Hospital | 1201 International Drive, Columbia, MO 65202 | 2018-05-23 |
| 1710409198 | Lena-frances Sheets | Counselor | 3509 Deer Run Drive, Columbia, MO 65202 | 2017-07-07 |
| 1235669037 | Henry William Clark | Counselor | 409 Vandiver West Bldg 6, Suite 102a, Great Circle, Columbia, MO 65202 | 2017-06-14 |
| 1083065148 | Waleed Raheem Abood Abood | Psychiatry & Neurology | 1 Hospital Drive, Ste 507, Columbia, MO 65202 | 2016-06-29 |
| 1871993923 | Li Ma | Physician Assistant | 1909 Mayberry Drive, Columbia, MO 65202 | 2014-08-26 |
| 1134543614 | Meghan Lees | Nurse Anesthetist, Certified Registered | 4608 Waterloo Driv, Ste 170, Columbia, MO 65202 | 2014-02-05 |
| 1467885053 | Laura Louise Cohen | Counselor | 19 E, Wanut St, Columbia, MO 65202 | 2013-08-19 |
| Find all providers in zip 65202 | ||||
| Taxonomy Code | 320600000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861954661 | La Bella Vita, LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 9400 S Smith Hatchery Rd, Columbia, MO 65203-8965 | 2019-04-02 |
| 1770092892 | Palmer's Home Care, LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 701 Hillsdale Road, Columbia, MO 65201 | 2017-09-20 |
| 1831432301 | Bredd Health Services | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 5984 Grand Banks Rd, Columbia, MD 21044-2733 | 2013-04-02 |
| 1225324866 | Wetogether Missouri, Inc. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 4702 Clark Ln, Apt. 201, Columbia, MO 65202-9920 | 2011-06-22 |
| 1629230677 | Scott Edward Williams | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 101 Dayspring Dr, Columbia, MO 65203-0285 | 2008-07-01 |
| 1326209990 | Brenda Dean Worstell | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 2505 Barrys Bluff Ct, Columbia, MO 65203-7260 | 2008-06-17 |
| 1013136613 | Columbia Developmental Center | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 132 Highway 850, Columbia, LA 71418-1559 | 2007-04-24 |
| 1407974389 | Cindy Christal | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 3100 Mexico Gravel Rd, Columbia, MO 65202-2631 | 2007-03-27 |
| 1003933540 | His Meiner Miracles | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 7770 E Mexico Gravel Rd, Columbia, MO 65202-8983 | 2007-03-22 |
| 1336279793 | Vested Optimium Community Services | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 8775 M- Centre Park Drive, # 515, Columbia, MD 21045 | 2007-03-06 |
| Find all providers in COLUMBIA | ||||
Please comment or provide details below to improve the information on CLARK SUPPORTED LIVING.
| 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.