Organization
DIANA'S BOARDING HOME 1, INC
Active
Other names
Diana's Boarding Home 1
Organization subpart
No
Provider details
NPI number
Authorized official
AMANDA WAGNER (OWNER)
(573) 866-2010
Entity
Organization
Contact information
Practice address
HC 64 BOX 4590, MARBLE HILL, MO 63764-9408
(573) 866-2010
Mailing address
HC 64 BOX 4590, MARBLE HILL, MO 63764-9408
(573) 866-2010
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
—
—
3104A0625X
Assisted Living Facility (Mental Illness)
Primary
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
Other
Enumeration date
03/05/2021
Last updated
03/05/2021
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