| NPI | 1932706603 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAREN ANTOINETTE JOHNSON Co Owner 573-528-6527 |
| Organization Subpart ? | No |
| Primary Taxonomy | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children |
| Additional Taxonomies | 311Z00000X Custodial Care Facility |
| Enumeration Date | 2020-10-06 |
| Last Update Date | 2020-10-06 |