Organization
COMMON GOOD-NATURAL LIVING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELLEN L LANCE (OWNER)
(660) 815-5270
Entity
Organization
Contact information
Practice address
215 HARRISON ST, MARSHALL, MO 65340-3715
(660) 815-5270
Mailing address
215 HARRISON ST, MARSHALL, MO 65340-3715
(660) 815-5270
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
—
—
Other
Enumeration date
07/19/2013
Last updated
11/12/2013
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