| NPI | 1508350133 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONTE DORSEY President 618-971-3332 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251C00000X |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 253J00000X Foster Care Agency | |
| 253Z00000X In Home Supportive Care | |
| 310400000X Assisted Living Facility | |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| 385HR2060X Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child | |
| Enumeration Date | 2018-06-18 |
| Last Update Date | 2018-06-18 |