| NPI | 1255599528 |
|---|---|
| Other Name | RUSSELL |
| Entity Type | Organization |
| Authorized Contact | DAVID MEYER Executive Director 314-652-6004 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 315P00000X Intermediate Care Facility, Intellectual Disabilities (Licence: MO 2452 10042) |
| Enumeration Date | 2008-05-23 |
| Last Update Date | 2008-05-23 |