Organization
DST INC
Active
Other names
Superior Park
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THOMAS A WALKER (PRESIDENT DST INC & ADMINISTRATOR)
(816) 630-3177
Entity
Organization
Contact information
Practice address
410 SUPERIOR, EXCELSIOR SPRINGS, MO 64024
(816) 630-3177
(816) 630-6100
Mailing address
PO BOX 126, 410 SUPERIOR, EXCELSIOR SPRINGS, MO 64024
(816) 630-3177
(816) 630-6100
Taxonomy
Speciality
Code
Description
License number
State
3104A0625X
Assisted Living Facility (Mental Illness)
033231
MO
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
035519
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
268002409
—
MO
Enumeration date
10/01/2007
Last updated
06/30/2008
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