| NPI | 1962576033 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS MANGOGNA President/CEO 314-652-6004 |
| Organization Subpart ? | No |
| Primary Taxonomy | 315P00000X Intermediate Care Facility, Intellectual Disabilities (Licence: MO 2452-10042) |
| Additional Taxonomies | 261QA0600X Clinic/Center, Adult Day Care |
| 315P00000X Intermediate Care Facility, Intellectual Disabilities (Licence: MO 2452-10039) | |
| 315P00000X Intermediate Care Facility, Intellectual Disabilities (Licence: MO 2452-10040) | |
| 315P00000X Intermediate Care Facility, Intellectual Disabilities (Licence: MO 2452-10041) | |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: MO 2452, 1460-7235) | |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2024-07-11 |