| NPI | 1790814176 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRUCE KOSMISKI Owner 660-665-9336 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: MO 5622-8623) |
| Enumeration Date | 2007-03-03 |
| Last Update Date | 2008-06-14 |