| NPI | 1164805198 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BONTIEA GOSS COO 417-869-8911 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: MO CC01430115) |
| Enumeration Date | 2015-07-08 |
| Last Update Date | 2015-07-08 |