Organization
MAPLE CREST RESIDENTIAL CARE FACILITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK ALLEN KEENEY (OWNER)
(573) 686-4490
Entity
Organization
Contact information
Practice address
307 N BROADWAY ST, POPLAR BLUFF, MO 63901-5103
(573) 686-4490
(573) 686-8817
Mailing address
307 N BROADWAY ST, POPLAR BLUFF, MO 63901-5103
(573) 686-4490
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
MO
Other
Enumeration date
03/07/2008
Last updated
03/07/2008
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