| NPI | 1639338759 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARRIE LYNN WOMACK Lead Office Assistant 417-256-0191 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: MO 294954102) |
| Enumeration Date | 2008-06-04 |
| Last Update Date | 2008-06-04 |