Provider Demographics
NPI:1194892372
Name:THE ROBERT L. KYLE CENTER FOR SEMI-INDEPENDENT LIVING
Entity type:Organization
Organization Name:THE ROBERT L. KYLE CENTER FOR SEMI-INDEPENDENT LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-341-5599
Mailing Address - Street 1:1201 TORY AVE
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401-4546
Mailing Address - Country:US
Mailing Address - Phone:573-341-5599
Mailing Address - Fax:573-341-5616
Practice Address - Street 1:1201 TORY AVE
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-4546
Practice Address - Country:US
Practice Address - Phone:573-341-5599
Practice Address - Fax:573-341-5616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251C00000X, 320600000X
MO857777007320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No251C00000XAgenciesDay Training, Developmentally Disabled Services