Provider Demographics
NPI:1568594380
Name:MINERAL AREA COMMUNITY PSYCHIATRIC REHABILITATION CENTER, INC.
Entity Type:Organization
Organization Name:MINERAL AREA COMMUNITY PSYCHIATRIC REHABILITATION CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE PROGRAM DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICKY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WINICK
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:573-756-2899
Mailing Address - Street 1:PO BOX 510
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-0510
Mailing Address - Country:US
Mailing Address - Phone:573-756-2899
Mailing Address - Fax:573-756-4105
Practice Address - Street 1:203 SOUTH WASHINGTON
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-0510
Practice Address - Country:US
Practice Address - Phone:573-756-2899
Practice Address - Fax:573-756-4105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO3607295261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health