| NPI | 1083741664 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KARLA K JONES Program Manager 573-581-8202 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: MO 6064-8839) |
| Enumeration Date | 2007-02-28 |
| Last Update Date | 2011-11-18 |