| NPI | 1154201341 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLEMENT BAGAZA Md 573-305-3703 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2025-09-06 |
| Last Update Date | 2025-09-06 |