| NPI | 1215056437 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DENSIE L SPOTILA Administrator 573-378-2266 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2008-07-02 |