Organization
SON SHINE HOME INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LEOTA FAYE DICKEN (ADMINISTRATOR PRES OF CORP OWNER)
(573) 785-0482
Entity
Organization
Contact information
Practice address
2056 HWY AA, POPLAR BLUFF, MO 63901-3789
(573) 785-0482
(573) 776-7278
Mailing address
2056 HWY AA, POPLAR BLUFF, MO 63901-3789
(573) 785-0482
(573) 776-7278
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
14308791
MO
Other
Enumeration date
02/01/2007
Last updated
08/22/2020
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