| NPI | 1427193077 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERESA L PORTER Credentialing Manager 636-466-6452 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 3245S0500X Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2024-08-29 |