Organization
PETTIS COUNTY ASSISTED LIVING, L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD J DESTEFANE (PRESIDENT)
(314) 543-3800
Entity
Organization
Contact information
Practice address
3017 BROOKING PARK AVE, SEDALIA, MO 65301-9327
(660) 827-3222
(660) 829-2217
Mailing address
1869 CRAIG PARK CT, SAINT LOUIS, MO 63146-4122
(314) 543-3800
(314) 543-3880
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
3104A0625X
Assisted Living Facility (Mental Illness)
—
—
Other
Enumeration date
02/15/2016
Last updated
02/15/2016
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