Organization
EVERGREEN GROUP HOME
Active
Other names
Pineview Group Home
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GARY D BOGGS (DIRECTOR)
(417) 722-4416
Entity
Organization
Contact information
Practice address
27 HOPPER TRL, URBANA, MO 65767-9234
(417) 722-4416
(417) 722-4417
Mailing address
27 HOPPER TRL, URBANA, MO 65767-9234
(417) 722-4416
(417) 722-4417
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
LC0556542
MO
Other
Enumeration date
06/27/2008
Last updated
06/27/2008
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