| NPI | 1861954661 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KALLIE LABELLA Owner/Provider 573-864-0089 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2019-04-02 |
| Last Update Date | 2021-03-25 |