| NPI | 1689844912 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTA MISSEY Executive Director 618-310-1549 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Additional Taxonomies | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Enumeration Date | 2008-03-03 |
| Last Update Date | 2015-12-22 |