| NPI | 1770258568 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY DANIELLE GREEN Program Director 314-393-1639 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Enumeration Date | 2021-08-12 |
| Last Update Date | 2021-08-12 |