Provider Demographics
NPI:1053510925
Name:RIGEL, MYRTLE EVELYN (BSW)
Entity Type:Individual
Prefix:MRS
First Name:MYRTLE
Middle Name:EVELYN
Last Name:RIGEL
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ROUTE 2
Mailing Address - Street 2:BOX 154
Mailing Address - City:KOSHKONONG
Mailing Address - State:MO
Mailing Address - Zip Code:65692
Mailing Address - Country:US
Mailing Address - Phone:417-867-1227
Mailing Address - Fax:
Practice Address - Street 1:320 STATE ROUTE F
Practice Address - Street 2:
Practice Address - City:KOSHKONONG
Practice Address - State:MO
Practice Address - Zip Code:65692-9206
Practice Address - Country:US
Practice Address - Phone:417-867-1227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO856321104Medicaid