Provider Demographics
NPI:1851438907
Name:NORTHWEST MISSOURI LIVING CENTER
Entity Type:Organization
Organization Name:NORTHWEST MISSOURI LIVING CENTER
Other - Org Name:NORTHWEST MO LEARNING CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WOODRING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-736-5523
Mailing Address - Street 1:302 MAPLE STREET
Mailing Address - Street 2:
Mailing Address - City:TARKIO
Mailing Address - State:MO
Mailing Address - Zip Code:64491
Mailing Address - Country:US
Mailing Address - Phone:660-736-5523
Mailing Address - Fax:660-736-5506
Practice Address - Street 1:302 MAPLE ST
Practice Address - Street 2:
Practice Address - City:TARKIO
Practice Address - State:MO
Practice Address - Zip Code:64491-1342
Practice Address - Country:US
Practice Address - Phone:660-736-5523
Practice Address - Fax:660-736-4884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMW 01168320900000X
320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO855331609Medicaid