Organization
GRACIE LANE DAY HAB, LLC
Active
Organization
GRACIE LANE DAY HAB, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MYRTLE E RIGEL BSW (OWNER/ADMINISTRATOR)
(417) 867-3397
Entity
Organization
Contact information
Practice address
RR 81 BOX 175, KOSHKONONG, MO 65692-8004
(417) 867-3397
(417) 867-3367
Mailing address
RR 81 BOX 175, KOSHKONONG, MO 65692-8004
(417) 867-3397
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
CC03100514
MO
385H00000X
Respite Care
CC03100514
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
856321104
—
MO
Enumeration date
03/18/2016
Last updated
03/22/2016
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