| NPI | 1811003551 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | C ROBERTO LINDBERG Executive Director 618-283-0638 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251C00000X |
| Additional Taxonomies | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| 343900000X Non-emergency Medical Transport (VAN) | |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2020-08-22 |