| NPI | 1861520124 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANNA SMITH Owner 417-626-2600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: MO 1504-9053) |
| Enumeration Date | 2007-03-01 |
| Last Update Date | 2020-08-22 |