Organization
GENESIS LIFE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES SWIFT (OWNER/ADMINISTRATOR)
(417) 270-0032
Entity
Organization
Contact information
Practice address
406 WINCHESTER STREET, WEST PLAINS, MO 65775
(417) 270-0032
Mailing address
PO BOX 528, WEST PLAINS, MO 65775-0528
(417) 270-0032
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Enumeration date
02/04/2011
Last updated
02/04/2011
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