| NPI | 1801121397 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JON GILLIOM Administrator 573-445-4409 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2009-10-16 |
| Last Update Date | 2009-10-16 |