COLUMBIA STREET RESIDENTIAL CARE CENTER, LLC (NPI# 1356908321) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356908321 |
| Entity Type | Organization |
| Organization Name | COLUMBIA STREET RESIDENTIAL CARE CENTER, LLC |
| Practice Address |
208 W Columbia St Farmington MO 63640-1705 |
| Mailing Address |
Po Box 272 Farmington MO 63640-0272 |
| Practice Telephone | 5733303760 |
| Mailing Telephone | 5733303760 |
| Enumeration Date | 2019-05-24 |
| Last Update Date | 2019-05-24 |
| Authorized Official Name | KAREN E. VEACH (OWNER) |
| Authorized Official Telephone | 5733303760 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3104A0625X |
Assisted Living Facility Specialization: Assisted Living, Mental Illness |
Nursing & Custodial Care Facilities |
| Street Address |
208 W COLUMBIA ST |
| City | FARMINGTON |
| State | MO |
| Zip Code | 63640-1705 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356539696 | Harris Care Centers, Inc. | Assisted Living Facility | 208 W Columbia St, Farmington, MO 63640-1705 | 2007-10-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316545254 | Brenda S Halton | Nurse Practitioner | 1010 West Columbia Street, Farmington, MO 63640 | 2020-10-13 |
| 1619519089 | Stacey Nicole Gillette | Counselor | 17885 Hart Pinkston Rd, Farmington, MO 63640 | 2019-10-17 |
| 1346890696 | Christopher Ryan Massey | Social Worker | 607 Pine St., Farmington, MO 63640 | 2019-09-18 |
| 1457909376 | Clarice Ogden | Social Worker | 203 South Washington Street, Farmington, MO 63640 | 2019-09-04 |
| 1861979718 | Clint Thebeau | In Home Supportive Care | 1276 W Liberty St, Farmington, MO 63640 | 2018-07-24 |
| 1023500600 | Lynn Machelle Knox | Counselor | 219 W Columbia St, Farmington, MO 63640 | 2018-05-31 |
| 1235620576 | Kim Bazzell | Registered Nurse | 1565 Ste. Genevieve Ave., Farmington, MO 63640 | 2018-05-22 |
| 1164919742 | Lincare Inc. | Durable Medical Equipment & Medical Supplies | 774 Market St, Farmington, MO 63640 | 2018-04-18 |
| 1184127813 | Michelle Lynette Corvallis | Chiropractor | 17 South Franklin St., Farmington, MO 63640 | 2018-03-08 |
| 1992206213 | Farmington Vision Care LLC | Optometrist | 110 E Harrison St, Farmington, MO 63640 | 2018-02-22 |
| Find all providers in zip 63640 | ||||
| Taxonomy Code | 3104A0625X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| Specialization | Assisted Living, Mental Illness |
| A facility providing supportive services to individuals who can function independently in most areas of activity, but need special guidance, assistance and/or monitoring as the result of a psychiatric problem. This type of facility requires a staff with special training in mental health training and dealing with psychiatric emergencies. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992822639 | Maple Ridge Residential Care LLC | Assisted Living Facility | 1034 Doris Dr, Farmington, MO 63640-1954 | 2007-03-26 |
| 1285766113 | Vicky L Winick | Assisted Living Facility | 5858 Busiek Rd, Farmington, MO 63640-7325 | 2007-03-09 |
| 1891352860 | Harris Residential Care Center, LLC | Assisted Living Facility | 401 S Henry St, Farmington, MO 63640-1823 | 2019-05-24 |
| 1710544788 | Carriage Residential Care Center, LLC | Assisted Living Facility | 508 N Washington St, Farmington, MO 63640-1756 | 2019-05-23 |
| 1407343791 | Maple Ridge Residential Care Center, LLC | Assisted Living Facility | 1034 Doris Dr, Farmington, MO 63640-1954 | 2018-04-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497356919 | Cardinal Ritter Institute-resident Services Corp | Assisted Living Facility | 5890 Eichelberger St, Saint Louis, MO 63109-3454 | 2020-11-02 |
| 1831798214 | Smith Care Residential, LLC | Assisted Living Facility | 130 W Culton St, Warrensburg, MO 64093-1720 | 2020-10-18 |
| 1063010890 | Mitchell's Care Center LLC | Assisted Living Facility | 1134 W Norton Rd, Springfield, MO 65803-1070 | 2020-10-14 |
| 1982201935 | J & J Assisted Living LLC | Assisted Living Facility | 104 Wesbecher Ln, Marble Hill, MO 63764 | 2020-10-02 |
| 1144862350 | Humble Abode Residence | Assisted Living Facility | 18 S Duchesne Dr, Florissant, MO 63031-8112 | 2019-10-09 |
| 1700437258 | Midwestern Medical Consultants LLC | Assisted Living Facility | 227 W. Franklin St, Liberty, MO 64068 | 2019-09-26 |
| 1790343804 | Calvin Akins | Assisted Living Facility | 4432 W Belle Pl, Saint Louis, MO 63108-2617 | 2019-06-04 |
| 1245893296 | Michele Vinson Investments LLC Dba Bolivar Manor House | Assisted Living Facility | 404 E Broadway St, Bolivar, MO 65613-2019 | 2019-04-16 |
| 1073079091 | Homes That Care Co. | Assisted Living Facility | 4144 Lindell Blvd Ste 312, Saint Louis, MO 63108-2953 | 2019-02-14 |
| 1609387240 | Tammy Michelle Stone | Assisted Living Facility | 431 Ne County Road 10564, Adrian, MO 64720-5111 | 2017-10-23 |
| Find all providers with the same taxonomy | ||||
| City | FARMINGTON |
| Zip Code | 63640 |
Please comment or provide details below to improve the information on COLUMBIA STREET RESIDENTIAL CARE CENTER, LLC.
| 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.