OrganizationActive
Board of Expanded Services
NPI 1679602049 · Intellectual and/or Developmental Disabilities Residential Treatment Facility · Carrollton, MO
Provider details
- NPI number
- 1679602049
- Entity type
- Organization
- Primary specialty
- Intellectual and/or Developmental Disabilities Residential Treatment FacilityResidential Treatment Facilities
- Organization subpart
- No
- Authorized official
- Ruth Thurlo, Executive Secretary(660) 542-1401
- License
- 852991900 (MO)
Specialties & taxonomies
- Intellectual and/or Developmental Disabilities Residential Treatment FacilityPrimary320600000XLicense 852991900 (MO)
Residential Treatment Facilities
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility320900000XLicense 852991900 (MO)
Residential Treatment Facilities
Practice location
1410 N Main St
Carrollton, MO 64633-1933
Phone: (660) 542-1401
Approximate (ZIP-level) locationGet directions
Mailing address
Po Box 455
Carrollton, MO 64633-0455
Other names (DBA / former)
- Doing business as
- Five Acres Group Home
Registry dates
- Enumerated
- 2007-03-03
- Last updated
- 2015-10-06
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.