Organization
PONY BIRD INCORPORATED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LINDA M DALLAS BSN, MAHSM (EXECUTIVE DIRECTOR)
(636) 931-5818
Entity
Organization
Contact information
Practice address
#1 PONY BIRD LANE, MAPAVILLE, MO 63065-0190
(636) 931-5818
(636) 931-3518
Mailing address
PO BOX 190, MAPAVILLE, MO 63065-0190
(636) 931-5818
(636) 931-3518
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
1351-8421
MO
Other
Enumeration date
03/30/2007
Last updated
08/22/2020
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