| NPI | 1518125319 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PENNY KING Administrator 660-229-0626 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2008-05-28 |
| Last Update Date | 2008-05-28 |