| NPI | 1033231303 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK R FORTIN President 816-509-5509 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2007-04-05 |
| Last Update Date | 2020-08-22 |