| NPI | 1699082743 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOUGLAS L EDGAR Owner/Qddp 573-424-4367 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| Enumeration Date | 2010-09-10 |
| Last Update Date | 2010-09-10 |