# COLONIAL HOUSE OF CRYSTAL CITY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Colonial House of Crystal City
- **Organization subpart:** No

## Provider details

- **NPI number:** 1962644401
- **Authorized official:** MRS. ALYSHA LYNN SAUER (MEMBER)
- **Authorized official phone:** (636) 933-4911

## Contact information

- **Practice address:** 26 MISSISSIPPI AVE, CRYSTAL CITY, MO 63019-1817
- **Practice address phone:** (636) 937-1000
- **Practice address fax:** (636) 937-1003
- **Mailing address:** 115 WEST AVE, FESTUS, MO 63028-1733
- **Mailing address phone:** (636) 933-4911
- **Mailing address fax:** (636) 933-9550

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 03/30/2009
- **Last updated:** 03/30/2009