| NPI | 1154452563 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TREVIS WAYNE ROARK Owner 660-826-3666 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2020-08-22 |