Organization
EQUILIBRIUM RANCH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTIAN B SHELTON (OWNER)
(314) 580-3029
Entity
Organization
Contact information
Practice address
81 PILKENTON LN, CUBA, MO 65453-8136
(573) 885-6443
(844) 851-0578
Mailing address
81 PILKENTON LN, CUBA, MO 65453-8136
(573) 885-6443
(844) 851-0578
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
251B00000X
Case Management Agency
—
—
3104A0625X
Assisted Living Facility (Mental Illness)
Primary
—
—
311ZA0620X
Adult Care Home Facility
—
—
364SL0600X
Long-Term Care Clinical Nurse Specialist
—
—
3747P1801X
Personal Care Attendant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1003364969
—
MO
05
—
1073655619
—
MO
05
—
1164781373
—
MO
05
—
1639213366
—
MO
05
—
1841769908
—
MO
Enumeration date
10/27/2021
Last updated
01/03/2025
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