| NPI | 1093418527 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASMINE DAVENPORT Director 314-203-8250 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2023-03-23 |
| Last Update Date | 2023-03-23 |