State of Missouri
NPI 1124198981 · Intellectual Disabilities Intermediate Care Facility · Poplar Bluff, MO
State of Missouri is a Intellectual Disabilities Intermediate Care Facility organization in Poplar Bluff, MO (NPI 1124198981).
Provider details
- NPI number
- 1124198981
- Entity type
- Organization
- Primary specialty
- Intellectual Disabilities Intermediate Care FacilityNursing & Custodial Care Facilities
- Parent organization
- State of Missouri
- Organization subpart
- Yes
- Authorized official
- Molly Boeckmann, Director of Administrative Services(573) 751-4055
- License
- EXEMPT (MO)
Specialties & taxonomies
Nursing & Custodial Care Facilities
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
19 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Other names (DBA / former)
- Doing business as
- Southeast Missouri Residential Services-Poplar Bluff
- Doing business as
- Southeast Missouri Residential Services-Poplar Bluff
Registry dates
- Enumerated
- 2006-11-09
- Last updated
- 2020-10-27
- Certified
- 2020-10-27
Frequently asked questions
- What is State of Missouri's NPI number?
- State of Missouri's National Provider Identifier (NPI) is 1124198981, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is State of Missouri?
- State of Missouri is classified in the NPPES registry as Intellectual Disabilities Intermediate Care Facility (Nursing & Custodial Care Facilities).
- Where is State of Missouri located?
- State of Missouri's practice location on file with NPPES is 2351 Kanell Blvd, Poplar Bluff, MO 63901-4035.
- What is State of Missouri's phone number?
- The practice phone number listed in the NPPES registry for State of Missouri is (573) 840-9370.
- Who is the authorized official for State of Missouri?
- The authorized official listed on State of Missouri's NPPES record is Molly Boeckmann, Director of Administrative Services. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is State of Missouri's NPI active?
- Yes — State of Missouri's NPI (1124198981) is active in the NPPES registry as of the last update on 2020-10-27.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.