Organization
BROOKSIDE CASA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DENSIE L SPOTILA (ADMINISTRATOR)
(573) 378-2266
Entity
Organization
Contact information
Practice address
17858 BROOKSIDE RD, BARNETT, MO 65011-3023
(573) 378-2266
(573) 378-2267
Mailing address
17858 BROOKSIDE RD, BARNETT, MO 65011-3023
(573) 378-2266
(573) 378-2267
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
856254107
—
MO
Enumeration date
03/28/2007
Last updated
07/02/2008
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