| NPI | 1467873711 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHAD LEWIS President 573-465-3654 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities (Licence: MO 2014011746) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2014-01-03 |
| Last Update Date | 2014-07-30 |