| NPI | 1790039261 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIM PAGE Therapist 573-200-1608 |
| Organization Subpart ? | No |
| Primary Taxonomy | 323P00000X Psychiatric Residential Treatment Facility (Licence: MO 2012008387) |
| Enumeration Date | 2012-11-05 |
| Last Update Date | 2012-11-05 |