Organization
HEAVEN SENT ISL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS DAMARA GAINES (ADMINISTRATOR)
(573) 886-2191
Entity
Organization
Contact information
Practice address
3001 YUKON DR, COLUMBIA, MO 65202-0922
(573) 886-2191
Mailing address
3001 YUKON DR, COLUMBIA, MO 65202-0922
(573) 886-2191
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
1982-8946
MO
Other
Enumeration date
03/23/2007
Last updated
07/01/2008
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