Organization
THERESEA OPEN ARMS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THERESEA MARCELLA GANAWAY (LPN)
(660) 882-6325
Entity
Organization
Contact information
Practice address
1277 SIECKMANN LN, BOONVILLE, MO 65233-2216
(660) 882-6325
Mailing address
1277 SIECKMANN LN, BOONVILLE, MO 65233-2216
(660) 882-6325
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
04/23/2007
Last updated
08/22/2020
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