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General NPI Number Information
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NPI Number | 1568594380
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Entity Type | Organization
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Legal Business Name | MINERAL AREA COMMUNITY PSYCHIATRIC REHABILITATION CENTER, INC.
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Dates
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Enumeration Date | 03/09/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 203 SOUTH WASHINGTON
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City | FARMINGTON
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State | MO
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Zip | 63640-0510
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Country | US
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Telephone | 573-756-2899
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Fax | 573-756-4105
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Provider Business Mailing Address
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Address Line | PO BOX 510
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City | FARMINGTON
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State | MO
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Zip | 63640-0510
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Country | US
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Telephone | 573-756-2899
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Fax | 573-756-4105
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Authorized Official
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Title or Position | EXECUTIVE PROGRAM DIRECTOR
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Name | MRS. VICKY LEE WINICK
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Credential | MSW
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Telephone | 573-756-2899
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 3607295
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License Number State | MO
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