| NPI | 1366564676 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACI WAGNER Owner 573-351-1221 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251C00000X |
| Additional Taxonomies | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| 385H00000X Respite Care | |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2020-08-22 |