Provider Demographics
NPI:1144932567
Name:MISSOURI GIRLS TOWN FOUNDATION, INC
Entity type:Organization
Organization Name:MISSOURI GIRLS TOWN FOUNDATION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING CLERK
Authorized Official - Prefix:
Authorized Official - First Name:MIRIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BURCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-642-5345
Mailing Address - Street 1:P.O. BOX 86
Mailing Address - Street 2:
Mailing Address - City:KINGDOM CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65262
Mailing Address - Country:US
Mailing Address - Phone:573-642-5345
Mailing Address - Fax:573-642-5162
Practice Address - Street 1:8548 JADE ROAD
Practice Address - Street 2:
Practice Address - City:KINGDOM CITY
Practice Address - State:MO
Practice Address - Zip Code:65262-0059
Practice Address - Country:US
Practice Address - Phone:573-642-5345
Practice Address - Fax:573-642-5162
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MISSOURI GIRLS TOWN FOUNDATION INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-12-16
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness