| NPI | 1972705341 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VARO DAVIS Administrator 314-862-1662 |
| Organization Subpart ? | No |
| Primary Taxonomy | 323P00000X Psychiatric Residential Treatment Facility (Licence: MO 267669505) |
| Enumeration Date | 2007-06-05 |
| Last Update Date | 2020-08-22 |