| NPI | 1689483620 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HOTTENSIAH BORO Owner 314-757-9424 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2025-01-03 |
| Last Update Date | 2025-01-03 |