| NPI | 1982247326 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACQUELINE ANN SISCO Co Owner/Administrator 417-372-1348 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2019-10-17 |
| Last Update Date | 2019-10-17 |