NPI: 1912125295 · BOONVILLE, MO 65233 · Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · NPI assigned 04/23/2007
| Authorized Official | GANAWAY, THERESEA (LPN) |
| NPI Enumeration Date | 04/23/2007 |
| Year | Claims | Total Paid |
|---|---|---|
| 2018 | 2,623 | $687K |