| NPI | 1639633290 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAIGE TUCK Executive Director 417-551-9192 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Enumeration Date | 2019-01-29 |
| Last Update Date | 2019-07-31 |