| NPI | 1730219833 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICIA ANN WEBER Owner Provider 660-886-4113 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2020-08-22 |