OrganizationActive
State of Missouri
NPI 1194933499 · Intellectual Disabilities Intermediate Care Facility · Saint Louis, MO
Provider details
- NPI number
- 1194933499
- 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
Specialties & taxonomies
Nursing & Custodial Care Facilities
Profile Score
Detailed profile(89/100 index)
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
2312 Lemay Ferry Rd
Saint Louis, MO 63125-3127
Phone: (314) 894-5400
Street-level locationGet directions
Mailing address
1706 E Elm St
Jefferson City, MO 65101-4130
Other names (DBA / former)
- Doing business as
- South County Habilitation Center
- Doing business as
- South County Habilitation Center
Registry dates
- Enumerated
- 2007-05-18
- Last updated
- 2020-08-26
- Certified
- 2020-08-26
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.