Organization
LASTING IMPRESSIONS MO LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEEGAN MICAH WASSAM (DIRECTOR)
(660) 951-1026
Entity
Organization
Contact information
Practice address
520 S LAMINE AVE, SEDALIA, MO 65301-4534
(660) 951-1026
(660) 951-1036
Mailing address
520 S LAMINE AVE, SEDALIA, MO 65301-4534
(660) 951-1026
(660) 951-1036
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
01/06/2025
Last updated
01/06/2025
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