| NPI | 1891955985 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KOBY STALEY Director 660-202-0045 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2008-06-11 |
| Last Update Date | 2008-06-11 |