Provider Demographics
NPI:1467453894
Name:RESIDENTIAL PSYCHIATRIC SERVICES, INC.
Entity Type:Organization
Organization Name:RESIDENTIAL PSYCHIATRIC SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MONA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:573-783-4292
Mailing Address - Street 1:1269 DOCTORS DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-2947
Mailing Address - Country:US
Mailing Address - Phone:573-664-1146
Mailing Address - Fax:573-664-1149
Practice Address - Street 1:1269 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-2947
Practice Address - Country:US
Practice Address - Phone:573-664-1146
Practice Address - Fax:573-664-1149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
MO0020601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO850830902OtherDMH
MO500830906Medicaid
MO500830906Medicaid