| NPI | 1336272764 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAMELA MORSE Accountant 618-252-0275 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251C00000X |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 251X00000X Supports Brokerage | |
| 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| 320700000X Residential Treatment Facility, Physical Disabilities | |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2015-09-30 |