MEDICARE: MISSOURI GIRLS TOWN FOUNDATION, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility		MO

General Provider Information

NPI Number	:	1831253137
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MISSOURI GIRLS TOWN FOUNDATION, INC

Provider Business Mailing Address
First Line	:	PO BOX 59
Second Line	:	8548 JADE ROAD
City	:	KINGDOM CITY
State	:	MO
Zip	:	65262-0059
Country	:	US
Telephone Number	:	573-642-5345
Fax Number	:	573-642-0891

Provider Business Practice Location Address
First Line	:	8548 JADE ROAD
Second Line	:
City	:	KINGDOM CITY
State	:	MO
Zip	:	65262
Country	:	US
Telephone Number	:	573-642-5345
Fax Number	:	573-642-0891

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. ROY FOWLES
Credential	:
Telephone Number	:	573-642-5345

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	08/22/2020

Similar Medicare Providers

1740353671 — NORTH CALLAWAY R-1 SCHOOL DISTRICT
Practice Location Address:

2690 US HIGHWAY 54
KINGDOM CITY, MO
65262-0033

Practice Phone: 573-386-2214
Practice Fax: 573-386-2169

1083788368 — MRS. MARY MICHELLE HUGHLEY
Practice Location Address:

2690 US HIGHWAY 54
KINGDOM CITY, MO
65262-0033

Practice Phone: 573-386-2217
Practice Fax:

1285701920 — MRS. TOBI LEE LINNEMAN
Practice Location Address:

2690 US HIGHWAY 54
KINGDOM CITY, MO
65262-0033

Practice Phone: 573-386-2214
Practice Fax: 573-386-2169

1356419329 — MRS. JENNIFER L. KALYANGO
Practice Location Address:

2690 US HIGHWAY 54
KINGDOM CITY, MO
65262-0033

Practice Phone: 573-386-2214
Practice Fax: 573-386-2169

1992869432 — SUE ELLEN MYERS
Practice Location Address:

8548 JADE ROAD
KINGDOM CITY, MO
65262

Practice Phone: 573-642-5345
Practice Fax: 573-642-5345

1417012972 — STACIE SMITHEE LCSW
Practice Location Address:

8548 JADE ROAD
KINGDOM CITY, MO
65262

Practice Phone: 573-642-5345
Practice Fax: 573-642-5345

Directions to “MISSOURI GIRLS TOWN FOUNDATION, INC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.