Organization
AZARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LINDA L MASHBURN (OWNER)
(417) 777-4948
Entity
Organization
Contact information
Practice address
4243 HIGHWAY D, BOLIVAR, MO 65613-9302
(417) 777-4948
Mailing address
4243 HIGHWAY D, BOLIVAR, MO 65613-9302
(417) 777-4948
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
14209362
MO
Other
Enumeration date
01/10/2007
Last updated
08/22/2020
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