| NPI | 1639476617 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCOTT DAVIS Sr. Business Director 618-529-3060 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| Additional Taxonomies | 251C00000X Day Training, Developmentally Disabled Services |
| Enumeration Date | 2011-02-28 |
| Last Update Date | 2014-03-28 |