| NPI | 1164692141 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY BAUER MIS Coordinator 618-282-6233 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Enumeration Date | 2008-03-06 |
| Last Update Date | 2008-04-20 |