Organization
BOONE SUPPORTED LIVING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JULIE WALDEN (MEMBER)
(573) 406-8010
Entity
Organization
Contact information
Practice address
5 MARSH CIR, HANNIBAL, MO 63401-2479
(573) 406-8010
Mailing address
5 MARSH CIR, HANNIBAL, MO 63401-2479
(573) 406-8010
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
04/24/2007
Last updated
08/22/2020
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