Provider Demographics
NPI:1851436828
Name:SHINN RESIDENTIAL CENTER, INC.
Entity Type:Organization
Organization Name:SHINN RESIDENTIAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHINN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-406-1523
Mailing Address - Street 1:817 PARIS AVE
Mailing Address - Street 2:
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-3223
Mailing Address - Country:US
Mailing Address - Phone:573-406-1523
Mailing Address - Fax:573-248-1091
Practice Address - Street 1:805 PARIS AVE
Practice Address - Street 2:SHINN RESIDENTIAL CENTER III
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401-3223
Practice Address - Country:US
Practice Address - Phone:573-221-3764
Practice Address - Fax:573-221-6225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2462-9303320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities