| NPI | 1184585622 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASMIN A BELL Program Manager 618-477-4868 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2025-11-24 |
| Last Update Date | 2026-10-02 |