Gracie Lane Day Hab, Llc
Gracie Lane Day Hab, Llc is a health care provider in Koshkonong, MO. In this page you will find its mailing address, practice location, phone number, specialty etc.
|Practice Location|| Rr 81 Box 175, Koshkonong, MO 65692-8004, US |
|Practice Location Phone||417-867-3397|
|Practice Location Fax||417-867-3367|
|Legal Business Name||GRACIE LANE DAY HAB, LLC|
|Enumeration Date ? ||Mar 18, 2016|
|Last Update Date ? ||Mar 22, 2016|
NPI: National Provider Identifier issued to health care providers by Centers for Medicare and Medicaid Services (CMS).
Specialties & Licenses of Gracie Lane Day Hab, Llc
|Specialty||Provider Type||Specialization||License||License State|
|Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities||Residential Treatment Facilities|| ||CC03100514||Missouri|
|Respite Care||Respite Care Facility|| ||CC03100514||Missouri|
Legacy Provider IDs of Gracie Lane Day Hab, Llc
|Provider Id||Issuer State||Issuer Type||Issuer|
Authorized Official of Gracie Lane Day Hab, Llc
An authorized official is an appointed official with the legal authority to make changes and/or updates to the Gracie Lane Day Hab, Llc's status and to commit the provider to fully abide by the laws and regulations relating to the National Provider Identifier (NPI).
|Authorized Official ||Mrs. Myrtle E Rigel (BSW)|
|Authorized Official Title/Position||OWNER/ADMINISTRATOR|
|Authorized Official Phone Number||417-867-3397|