| NPI | 1093061863 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KERRY L. BRAMON President 573-875-0794 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2012-07-31 |
| Last Update Date | 2012-11-07 |