Organization
LETTUCE DREAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HEATHER D THORNTON (PROGRAM MANAGER)
(660) 224-2203
Entity
Organization
Contact information
Practice address
1623 E 2ND ST, MARYVILLE, MO 64468-1959
(660) 224-2203
(660) 224-2203
Mailing address
PO BOX 272, MARYVILLE, MO 64468-0272
(660) 224-2203
(660) 224-2203
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
MO
347C00000X
Private Vehicle
—
—
Other
Enumeration date
12/18/2017
Last updated
12/18/2017
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