| NPI | 1891063400 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREA KAY ZOELLNER Executive Director 573-883-3330 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Additional Taxonomies | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2011-12-09 |
| Last Update Date | 2013-02-20 |