Organization
DIANA'S BOARDING HOME 2 INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TERRY DUSTIN WAGNER (OWNER/PRESIDENT)
(573) 238-3344
Entity
Organization
Contact information
Practice address
4677 STATE HWY M, MARBLE HILL, MO 63764-9408
(573) 238-3344
(573) 238-3361
Mailing address
HC 64 BOX 4677, MARBLE HILL, MO 63764-9408
(573) 238-3344
(573) 238-3361
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
02/19/2021
Last updated
02/19/2021
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