Organization
GREEN ACRES RESIDENTIAL CARE FACILITY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HOLLY GREEN (OWNER)
(573) 756-2917
Entity
Organization
Contact information
Practice address
3688 SAND CREEK RD, FARMINGTON, MO 63640-7350
(573) 756-2917
Mailing address
3688 SAND CREEK RD, FARMINGTON, MO 63640-7350
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
043352
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
043352
—
MO
Enumeration date
08/20/2015
Last updated
08/20/2015
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