| NPI | 1386888311 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEROME RENEA BRACELY Executive Director 314-231-5175 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 251V00000X Voluntary or Charitable |
| Enumeration Date | 2009-04-21 |
| Last Update Date | 2009-04-21 |