| NPI | 1821669839 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIEDRE FOOTE C FOOTE Executive Director 618-980-3117 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2021-07-09 |
| Last Update Date | 2021-07-09 |