| NPI | 1417577107 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACY GLENN Clinical Director 314-392-3822 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2020-04-22 |
| Last Update Date | 2020-04-22 |