| NPI | 1275128845 |
|---|---|
| Doing Business As | DIANA'S BOARDING HOME 1 |
| Entity Type | Organization |
| Authorized Contact | AMANDA WAGNER Owner 573-866-2010 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3104A0625X Assisted Living Facility, Assisted Living, Mental Illness |
| Additional Taxonomies | 310400000X Assisted Living Facility |
| 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| Enumeration Date | 2021-03-05 |
| Last Update Date | 2021-03-05 |