Organization
ANNIE'S HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ASHLEY ANN LEE (ADMINISTRATOR)
(573) 310-9333
Entity
Organization
Contact information
Practice address
1107B AMHERST ST, FULTON, MO 65251-2373
(573) 310-9333
Mailing address
1107B AMHERST ST, FULTON, MO 65251-2373
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
320700000X
Physical Disabilities Residential Treatment Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
07/20/2008
Last updated
07/20/2008
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