Healthcare Provider Details

I. General information

NPI: 1942331830
Provider Name (Legal Business Name): POGUES ENHANCED LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5031 LINWOOD DR
POPLAR BLUFF MO
63901
US

IV. Provider business mailing address

5031 LINWOOD DR
POPLAR BLUFF MO
63901
US

V. Phone/Fax

Practice location:
  • Phone: 573-686-5219
  • Fax:
Mailing address:
  • Phone: 573-686-5219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARY POGUE
Title or Position: OWNER
Credential:
Phone: 573-686-5219