| NPI | 1477052058 |
|---|---|
| Other Name | THE PETROVA HOUSE |
| Entity Type | Organization |
| Authorized Contact | MARVIN SHELTON CEO 314-580-3029 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3104A0625X Assisted Living Facility, Assisted Living, Mental Illness |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 251B00000X Case Management | |
| 253Z00000X In Home Supportive Care | |
| 261QV0200X Clinic/Center, VA | |
| 3104A0630X Assisted Living Facility, Assisted Living, Behavioral Disturbances | |
| 323P00000X Psychiatric Residential Treatment Facility | |
| 324500000X Substance Abuse Rehabilitation Facility | |
| 3336M0003X Pharmacy, Managed Care Organization Pharmacy | |
| Enumeration Date | 2018-02-08 |
| Last Update Date | 2018-02-08 |