| NPI | 1285227397 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRY DUSTIN WAGNER Owner/President 573-238-3344 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Enumeration Date | 2021-02-19 |
| Last Update Date | 2021-02-19 |