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Type 2 · Organization ✓ Active NPI ✓ Valid NPI checksum Organization subpart

State of Missouri

Intellectual Disabilities Intermediate Care Facility in Poplar Bluff, MO · enumerated 2006 · authorized official Molly Boeckmann, Director of Administrative Services.

Data current as of Jul 13, 2026 · sourced from CMS NPPES

National Provider Identifier

1124198981

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Registry record

Entity type Organization (Type 2)
Legal business name State of Missouri
Other name <Unavail>
Parent organization State of Missouri
Practice address 2351 Kanell Blvd, Poplar Bluff, MO, 63901
Phone (573) 840-9370
Fax (573) 840-9373
Enumeration date Nov 9, 2006
Last updated in NPPES Oct 27, 2020

Taxonomy & classification

315P00000X Intellectual Disabilities Intermediate Care Facility Nursing & Custodial Care Facilities · License EXEMPT (MO) Primary

Authorized official

Name Molly Boeckmann
Title Director of Administrative Services
Phone (573) 751-4055

Other identifiers

Identifier Type State Issuer
051793107 Medicaid MO -

What is an NPI number?

A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes, even if the provider moves or changes specialty.

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Frequently asked questions

Who is the authorized official for State of Missouri?
NPPES lists Molly Boeckmann (Director of Administrative Services) as the authorized official for this organization.
What is the NPI number for State of Missouri?
The NPI for State of Missouri is 1124198981, a Type 2 (organization) record in the CMS NPPES registry.

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Source: CMS NPPES (public data). Snapshot 2026-07-13. Provider record last updated 2020-10-27.