| NPI | 1043583818 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAULA DEEANNE LUNA Independent Contractor 660-442-5566 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2012-02-09 |
| Last Update Date | 2012-02-09 |