| NPI | 1255407201 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRY COMBS Executive Director 660-665-1111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2013-03-06 |