| NPI | 1528125788 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERESA PORTER Credentialing Manager 660-890-8156 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2024-09-02 |