| NPI | 1417004623 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERESA PORTER Credentialing Manager 636-466-6452 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 253Z00000X In Home Supportive Care |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 251E00000X Home Health | |
| 261QP2300X Clinic/Center, Primary Care | |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2023-11-04 |