| NPI | 1861868135 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HOLLY GREEN Owner 573-756-2917 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities (Licence: MO 043352) |
| Enumeration Date | 2015-08-20 |
| Last Update Date | 2015-08-20 |