MEDICARE: REM MISSOURI, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	103K00000X	Behavior Analyst
2	106S00000X	Behavior Technician
3	106E00000X	Assistant Behavior Analyst
4	261QD1600X	Developmental Disabilities Clinic/Center

General Provider Information

NPI Number	:	1962083493
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REM MISSOURI, LLC

Provider Business Mailing Address
First Line	:	11872 WESTLINE INDUSTRIAL DR STE 100
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63146-3331
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11872 WESTLINE INDUSTRIAL DR STE 100
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63146-3331
Country	:	US
Telephone Number	:	660-815-4997
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	RACHEL KRAMER
Credential	:
Telephone Number	:	660-815-4997

Provider Enumeration Date	:	04/16/2021
Last Update Date	:	07/08/2023

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