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General NPI Number Information
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NPI Number | 1902251507
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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 | 05/02/2016
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Last Update Date | 05/02/2016
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Provider Practice Location Address
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Address Line | 560 W PINE ST
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City | FARMINGTON
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State | MO
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Zip | 63640-1426
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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 | 560 W PINE ST P O BOX 510
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City | FARMINGTON
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State | MO
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Zip | 63640-1426
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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 | PRESIDENT EXECUTIVE DIRECTOR
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Name | MRS. VICKY L WINICK
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Credential | LMSW
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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 | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 2162
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 2162
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License Number State | MO
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