KYBAMA, INC (NPI# 1437675477) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1437675477 |
| Entity Type | Organization |
| Organization Name | KYBAMA, INC |
| Practice Address |
12729 Stoney Point Rd Bonne Terre MO 63628 |
| Mailing Address |
Po Box 70 Potosi MO 63664-0070 |
| Practice Telephone | 5733588703 |
| Enumeration Date | 2017-08-22 |
| Last Update Date | 2017-08-22 |
| Authorized Official Name | GARY SELBERT (PROGRAM DIRECTOR) |
| Authorized Official Telephone | 3149608639 |
| Authorized Official Credential | LPC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | Residential Treatment Facilities |
| Street Address |
12729 STONEY POINT RD |
| City | BONNE TERRE |
| State | MO |
| Zip Code | 63628 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295092500 | Jak Properties Inc | In Home Supportive Care | 522 Benham St, Suite B, Bonne Terre, MO 63628 | 2012-04-12 |
| 1013121599 | Joseph Richard Engel | Dentist | 20 W Johnson St, Bonne Terre, MO 63628 | 2007-05-10 |
| 1215093844 | Debra Long Morgan | Dentist | 20 West Johnson Street, Bonne Terre, MO 63628 | 2006-12-28 |
| 1497811459 | Robert Oliver Greenwald | Dentist | #20 W Johnson, Bonne Terre, MO 63628 | 2006-12-27 |
| 1255964508 | American Nursing & Rehab LLC | Assisted Living Facility | 10 Lake Drive, Bonne Terre, MO 63628 | 2020-02-14 |
| 1962679746 | Robert O Greenwald Dds PC | Dentist | #20 W Johnson, Bonne Terre, MO 63628 | 2008-05-12 |
| 1427045004 | Pairat Vibulakaopun | Internal Medicine | 527 Benham St, Bonne Terre, MO 63628-1205 | 2005-09-29 |
| 1124014030 | Kenny Ratana | Radiology | 527 Benham St # B, Bonne Terre, MO 63628-1205 | 2005-09-26 |
| 1669017315 | Patricia Ann Peterson | Nurse Practitioner | 527 Benham St, Bonne Terre, MO 63628-1205 | 2019-11-15 |
| 1225562077 | Ronay Rodgers | Nurse Practitioner | 527 Benham St, Bonne Terre, MO 63628-1205 | 2017-04-19 |
| Find all providers in zip 63628 | ||||
| Taxonomy Code | 322D00000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Emotionally Disturbed Children |
| A provider facility or distinct part of the organization which renders an interdisciplinary program of mental health treatment to individuals under 21 years of age who have persistent dysfunction in major life areas. The dysfunction is of an extent and pervasiveness that requires a protected and highly structured therapeutic environment. These organizations, or distinct part of organizations, exclude those that provide acute psychiatric care, partial hospitalization, group living, therapeutic schooling, primary diagnosis substance abuse disorder treatment, or primary diagnosis mental retardation or developmental disability treatment. |
| Notes: Source: U.S. Department of Defense Regulation 6010.8-R, Chapter 6. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609474204 | Whetstone Boys Ranch | Residential Treatment Facility, Emotionally Disturbed Children | 6850 County Road 2660, Mountain View, MO 65548-8146 | 2020-10-15 |
| 1962995993 | The Bridge Home for Children | Residential Treatment Facility, Emotionally Disturbed Children | 6033 Swope Pkwy, Kansas City, MO 64130-4461 | 2018-06-13 |
| 1568914927 | Clear Creek Counseling | Residential Treatment Facility, Emotionally Disturbed Children | 3646 N Farm Road 89, Willard, MO 65781-8330 | 2016-11-01 |
| 1619330578 | Farmer Grove Homesteads Incorporated | Residential Treatment Facility, Emotionally Disturbed Children | 533 E Bedford St, Marshfield, MO 65706-1218 | 2016-03-29 |
| 1720447212 | Corner Stones of Care | Residential Treatment Facility, Emotionally Disturbed Children | 300 E 36th St, Kansas City, MO 64111-1410 | 2016-02-12 |
| 1558729509 | Cayman's House of Hope, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 311 N Poplar St, Fair Play, MO 65649-9299 | 2016-02-05 |
| 1639503691 | Proverb Academy, Inc | Residential Treatment Facility, Emotionally Disturbed Children | 420 Carroll St, Morehouse, MO 63868 | 2013-08-27 |
| 1306147277 | Fair Haven Children's Home | Residential Treatment Facility, Emotionally Disturbed Children | 3132 N Fair Haven Loop, Strafford, MO 65757-8619 | 2010-11-09 |
| 1437470184 | Ozarks Teen Challenge | Residential Treatment Facility, Emotionally Disturbed Children | 512 Purist Lane, Branson West, MO 65737 | 2010-06-17 |
| 1275850869 | Victory Mountain, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 148 Bowling Ln, Ironton, MO 63650-4148 | 2010-04-22 |
| Find all providers with the same taxonomy | ||||
| City | BONNE TERRE |
| Zip Code | 63628 |
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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.