Organization
LACI'S HAVEN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIA LEWIS RN (DIRECTOR, ADMINISTRATOR, PRESIDENT)
(573) 201-8654
Entity
Organization
Contact information
Practice address
713 SALEM AVE, SUITE E, ROLLA, MO 65401-3444
(573) 465-3654
(888) 858-8055
Mailing address
713 SALEM AVE, SUITE E, ROLLA, MO 65401-3444
(573) 201-8654
(888) 858-8055
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
06/10/2013
Last updated
10/11/2017
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