Healthcare Provider Details

I. General information

NPI: 1730241688
Provider Name (Legal Business Name): THE ROBERT L. KYLE CENTER FOR SEMI-INDEPENDENT LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 TORY AVE
ROLLA MO
65401-4546
US

IV. Provider business mailing address

1201 TORY AVE
ROLLA MO
65401-4546
US

V. Phone/Fax

Practice location:
  • Phone: 573-341-5599
  • Fax: 573-341-5616
Mailing address:
  • Phone: 573-341-5599
  • Fax: 573-341-5616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number StateMO

VIII. Authorized Official

Name: DENISE BARNER
Title or Position: ADMINISTRATOR
Credential:
Phone: 573-341-5599