| NPI | 1154047876 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COREY R SCOTT Assistant Director 636-584-5078 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2022-10-14 |
| Last Update Date | 2022-10-14 |