| NPI | 1184754046 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TINA D MAURIZI Owner 573-256-1296 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: MO 856917109) |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2008-04-09 |