| NPI | 1518121128 |
|---|---|
| Former Legal Business Name | NONE AT THIS TIME |
| Entity Type | Organization |
| Authorized Contact | NICOLE MICHEELE BROCK-WILLIAMS Director 314-440-8087 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 385HR2060X Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child |
| Additional Taxonomies | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2008-07-12 |
| Last Update Date | 2008-07-12 |