OrganizationActive
State of Missouri
NPI 1942442702 · Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Saint Louis, MO
Provider details
- NPI number
- 1942442702
- Entity type
- Organization
- Primary specialty
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityResidential Treatment Facilities
- Parent organization
- State of Missouri
- Organization subpart
- Yes
- Authorized official
- Molly Boeckmann, Director of Administrative Services(573) 751-4055
Specialties & taxonomies
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityPrimary320900000X
Residential Treatment Facilities
Profile Score
Detailed profile(85/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
17 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
11 Brady Cir
Saint Louis, MO 63114-1110
Phone: (314) 877-1624
Fax: (314) 877-5666
Street-level locationGet directions
Mailing address
1706 E Elm St
Jefferson City, MO 65101-4130
Other names (DBA / former)
- Doing business as
- St. Louis Developmental Disabilities Treatment Center Isl
- Doing business as
- St. Louis Developmental Disabilities Treatment Center Isl
Registry dates
- Enumerated
- 2009-03-25
- Last updated
- 2020-08-28
- Certified
- 2020-08-28
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.