| NPI | 1972633410 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY LYNNE LAROSE CFO 573-450-2530 |
| Organization Subpart ? | No |
| Primary Taxonomy | 282E00000X (Licence: MO 503-0) |
| Additional Taxonomies | 273Y00000X Rehabilitation Unit |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2024-05-07 |