Organization
BOARD OF EXPANDED SERVICES
Active
Other names
FIVE ACRES GROUP HOME
Organization subpart
No
Provider details
NPI number
Authorized official
RUTH A THURLO (EXECUTIVE SECRETARY)
(660) 542-1401
Entity
Organization
Contact information
Practice address
1410 N MAIN ST, CARROLLTON, MO 64633-1933
(660) 542-1401
Mailing address
PO BOX 455, CARROLLTON, MO 64633-0455
(660) 542-1401
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
852991900
MO
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
852991900
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
852991900
—
MO
Enumeration date
03/03/2007
Last updated
10/06/2015
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