MEDICARE: MISSOURI COMMUNITY ADVANCEMENT NETWORK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1427901594
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MISSOURI COMMUNITY ADVANCEMENT NETWORK

Provider Business Mailing Address
First Line	:	1043 E TERRA LN
Second Line	:
City	:	O FALLON
State	:	MO
Zip	:	63366-2750
Country	:	US
Telephone Number	:	931-434-3358
Fax Number	:	636-754-0643

Provider Business Practice Location Address
First Line	:	1043 E TERRA LN
Second Line	:
City	:	O FALLON
State	:	MO
Zip	:	63366-2750
Country	:	US
Telephone Number	:	931-434-3358
Fax Number	:	636-754-0643

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RALEIGH FRYE
Credential	:
Telephone Number	:	931-434-3358

Provider Enumeration Date	:	02/18/2026
Last Update Date	:	02/18/2026

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