| NPI | 1093514200 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EBONY S HAGENS Owner 314-665-9134 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 251E00000X Home Health |
| 253J00000X Foster Care Agency | |
| 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| 320700000X Residential Treatment Facility, Physical Disabilities | |
| 385H00000X Respite Care | |
| 385HR2060X Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child | |
| Enumeration Date | 2025-03-10 |
| Last Update Date | 2025-05-08 |