| NPI | 1255505939 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES RAY DICKERSON Provider 816-353-8850 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: MO 9227) |
| Enumeration Date | 2008-04-14 |
| Last Update Date | 2008-04-14 |