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Organization

ALICE SUE CONRAD

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. ALICE SUE CONRAD (OWNER)
(573) 875-6751
Entity
Organization

Contact information

Practice address
1407 SAINT ANDREW ST, COLUMBIA, MO 65203-2327
(573) 875-6751
(573) 442-2086
Mailing address
1407 SAINT ANDREW ST, COLUMBIA, MO 65203-2327
(573) 875-6751
(573) 442-2086

Taxonomy

Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
8001661
MO

Other

Enumeration date
03/29/2007
Last updated
06/13/2008
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