CLOSE2HOME4LIFE LLC — NPI 1235918590 (Licensed & Credentialed Assisted Living Facility, Assisted Living, Mental Illness in MALDEN, MO)

CMS-1500 Box 24J / 33a • NPI

1235918590

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

3104A0625X

Licensed & Credentialed Assisted Living Facility, Assisted Living, Mental Illness

Box 32 Service Location & ZIP+4

620 N GOLDSMITH ST, MALDEN, MO, 63863-1734

✓ 9-Digit EDI 837 ZIP+4 (63863-1734)

Practice Phone & Referral Fax

(573) 901-0200

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1235918590 (CLOSE2HOME4LIFE LLC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1235918590` (NPI-2 Organization / Facility)
Provider / Legal Name	CLOSE2HOME4LIFE LLC
Plain-English Specialty	Licensed & Credentialed Assisted Living Facility, Assisted Living, Mental Illness NUCC Code: `3104A0625X` (Assisted Living Facility, Assisted Living, Mental Illness)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	620 N GOLDSMITH ST, MALDEN, MO, 63863-1734
Practice Telephone / Fax	Tel: (573) 901-0200
Administrative Mailing Address	102 E HOWARD ST, MALDEN, MO, 63863-2031
Enumeration & Last Sync	Enumerated: 2023-09-26 \| CMS Record Updated: 2023-09-26
Authorized Official	STACY SPEER (Owner/Manager)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

620 N GOLDSMITH ST, MALDEN, MO, 63863-1734

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Plain-English Taxonomy & CMS Crosswalk (3104A0625X)

What Does Taxonomy Code 3104A0625X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 3104A0625X translates to:
"Licensed & Credentialed Assisted Living Facility, Assisted Living, Mental Illness"

CMS-1500 Medicare Specialty Crosswalk: Standard HIPAA X12N 837P / CMS-1500
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Assisted Living Facility, Assisted Living, Mental Illness for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (CLOSE2HOME4LIFE LLC)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`174200000X` — Meals Plain English: Licensed & Credentialed Meals	State: N/A \| License: `Verified` \| Primary: Secondary
`177F00000X` — Lodging Plain English: Licensed & Credentialed Lodging	State: N/A \| License: `Verified` \| Primary: Secondary
`251B00000X` — Case Management Plain English: Licensed & Credentialed Case Management	State: N/A \| License: `Verified` \| Primary: Secondary
`251J00000X` — Nursing Care Plain English: Licensed Skilled Nursing & Inpatient Post-Acute Rehabilitation Facility (SNF)	State: N/A \| License: `Verified` \| Primary: Secondary
`251K00000X` — Public Health or Welfare Plain English: Licensed & Credentialed Agencies — Public Health or Welfare	State: N/A \| License: `Verified` \| Primary: Secondary
`251S00000X` — Community/Behavioral Health Plain English: Licensed & Credentialed Community/Behavioral Health	State: N/A \| License: `Verified` \| Primary: Secondary
`3104A0630X` — Assisted Living Facility, Assisted Living, Behavioral Disturbances Plain English: Licensed & Credentialed Assisted Living Facility, Assisted Living, Behavioral Disturbances	State: N/A \| License: `Verified` \| Primary: Secondary
`320600000X` — Residential Treatment Facility, Intellectual and/or Developmental Disabilities Plain English: Licensed & Credentialed Residential Treatment Facility, Intellectual and/or Developmental Disabilities	State: N/A \| License: `Verified` \| Primary: Secondary
`385H00000X` — Respite Care Plain English: Licensed & Credentialed Respite Care	State: N/A \| License: `Verified` \| Primary: Secondary
`3104A0625X` — Assisted Living Facility, Assisted Living, Mental Illness Plain English: Licensed & Credentialed Assisted Living Facility, Assisted Living, Mental Illness	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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CLOSE2HOME4LIFE LLC (NPI #1235918590)