| NPI | 1992842058 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON F FORREST President 800-386-8279 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: MO 19184786) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2011-12-14 |