| NPI | 1770628828 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALLEN TACKER Executive Director 573-443-2204 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder |
| 261QM2800X Clinic/Center Methadone | |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2020-08-22 |