Organization
GOOD SAMARITAN BOYS RANCH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK ANDREW MAINE (DIRECTOR OF INFORMATION TECHNOLOGY)
(417) 376-2238
Entity
Organization
Contact information
Practice address
5549 N HIGHWAY 13, BRIGHTON, MO 65617-8112
(417) 376-2238
Mailing address
PO BOX 617, BRIGHTON, MO 65617-0617
(417) 376-2238
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
—
Other
Enumeration date
07/03/2007
Last updated
10/26/2022
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