Organization
LAKESHORES RESIDENTIAL CARE FACILITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS SANDRA RUTHERFORD (MANAGER)
(417) 722-4416
Entity
Organization
Contact information
Practice address
27 HOPPER TRL, URBANA, MO 65767-9234
(417) 722-4416
(417) 722-4417
Mailing address
PO BOX 385, PRESTON, MO 65732-0385
(417) 722-4166
(417) 722-4417
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Enumeration date
03/27/2007
Last updated
06/09/2020
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