Organization
PULASKI COUNTY GROUP HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BOBBIE JEAN MORRIS (ADMINISTRATOR)
(573) 736-5603
Entity
Organization
Contact information
Practice address
307 KEETH ROAD, CROCKER, MO 65452
(573) 736-5603
(573) 736-2771
Mailing address
PO BOX 662, CROCKER, MO 65452-0662
(573) 736-5603
(573) 736-2771
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
385H00000X
Respite Care
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
853890804
—
MO
Enumeration date
04/02/2007
Last updated
02/17/2010
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