Provider Demographics
NPI:1003934126
Name:MISSOURI QUALITY CARE
Entity Type:Organization
Organization Name:MISSOURI QUALITY CARE
Other - Org Name:CROSSROADS COUNTRY HOME
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:TYLER
Authorized Official - Last Name:THORNTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-632-3773
Mailing Address - Street 1:215 S WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:MO
Mailing Address - Zip Code:64429-2265
Mailing Address - Country:US
Mailing Address - Phone:816-632-3773
Mailing Address - Fax:816-632-3335
Practice Address - Street 1:215 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:MO
Practice Address - Zip Code:64429-2265
Practice Address - Country:US
Practice Address - Phone:816-632-3773
Practice Address - Fax:816-632-3335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1576-9788320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO857883508Medicaid