| NPI | 1235511692 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DALE A MAXVILLE President/Owner 573-864-9743 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2015-06-22 |
| Last Update Date | 2015-06-22 |