| NPI | 1699213603 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IESHA POWELL Owner / Program Director 314-715-4666 |
| Organization Subpart ? | No |
| Primary Taxonomy | 315P00000X Intermediate Care Facility, Intellectual Disabilities |
| Enumeration Date | 2017-02-09 |
| Last Update Date | 2017-02-09 |