Organization
MY PLACE RESIDENTIAL CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY L. CASEY LPN, LNHA (ADMINISTRATOR)
(636) 933-1793
Entity
Organization
Contact information
Practice address
23 N 6TH ST, FESTUS, MO 63028-1301
(636) 933-1793
(636) 933-6446
Mailing address
23 N 6TH ST, FESTUS, MO 63028-1301
(636) 933-1793
(636) 933-6446
Taxonomy
Speciality
Code
Description
License number
State
311Z00000X
Custodial Care Facility
032831
MO
311Z00000X
Custodial Care Facility
Primary
033990
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
032831
DHSS
MO
Enumeration date
06/04/2007
Last updated
08/22/2020
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