| NPI | 1093213092 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACEY BERRY Owner 618-567-1277 |
| Organization Subpart ? | No |
| Primary Taxonomy | 163WH0200X Registered Nurse, Home Health |
| Additional Taxonomies | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| Enumeration Date | 2018-01-25 |
| Last Update Date | 2018-01-25 |