| NPI | 1083073498 |
|---|---|
| Former Legal Business Name | DILLAHUNT ISL |
| Entity Type | Organization |
| Authorized Contact | NANCY JANE DILLAHUNT Provider 573-445-4408 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 315P00000X Intermediate Care Facility, Intellectual Disabilities (Licence: MO 093669) |
| Enumeration Date | 2016-02-12 |
| Last Update Date | 2016-03-03 |