Healthcare Provider Details

I. General information

NPI: 1154191963
Provider Name (Legal Business Name): RAPHA HOUSE INTERNATIONAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2024
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 S MAIN ST
JOPLIN MO
64801-4502
US

IV. Provider business mailing address

2501 E 20TH ST
JOPLIN MO
64804-1037
US

V. Phone/Fax

Practice location:
  • Phone: 417-621-0373
  • Fax: 417-512-9120
Mailing address:
  • Phone: 417-621-0373
  • Fax: 417-512-9132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MR. ANTHONY GEISER
Title or Position: CHIEF FINANCE OFFICER
Credential:
Phone: 417-512-9141