| NPI | 1336646678 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MAVIS PANFORD Program Director 573-855-1210 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: AZ BH5412) |
| Enumeration Date | 2018-04-12 |
| Last Update Date | 2018-04-12 |