| NPI | 1528469772 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DENISE HAGEMANN Otr/L 573-552-8007 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: MO 016604) |
| Additional Taxonomies | 251E00000X Home Health (Licence: MO 016604) |
| 252Y00000X Early Intervention Provider Agency (Licence: MO 016604) | |
| 305R00000X Preferred Provider Organization (Licence: MO 016604) | |
| Enumeration Date | 2014-09-08 |
| Last Update Date | 2015-05-22 |