Organization
INDEPEDENCE CENTER OF STE. GENEVIEVE COUNTY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ANDREA KAY ZOELLNER (EXECUTIVE DIRECTOR)
(573) 883-3330
Entity
Organization
Contact information
Practice address
21530 HWY 32, SUITE B, STE GENEVIEVE, MO 63670-8813
(573) 883-3330
(573) 883-3332
Mailing address
21530 HWY 32, SUITE B, STE GENEVIEVE, MO 63670-8813
(573) 883-3330
(573) 883-3332
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
Other
Enumeration date
12/09/2011
Last updated
02/20/2013
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