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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.

physician-icon Basic Information

Practice Location Rr 81 Box 175, Koshkonong, MO 65692-8004, US
Practice Location Phone417-867-3397
Practice Location Fax417-867-3367
Legal Business NameGRACIE LANE DAY HAB, LLC
NPI ?1881055812
Entity TypeOrganization
Enumeration Date ? Mar 18, 2016
Last Update Date ? Mar 22, 2016
Note:
NPI: National Provider Identifier issued to health care providers by Centers for Medicare and Medicaid Services (CMS).

specialty-icon Specialties & Licenses of Gracie Lane Day Hab, Llc

SpecialtySpecializationLicenseLicense State
Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities CC03100514Missouri
Respite Care CC03100514Missouri

legacy-id-icon Legacy Provider IDs of Gracie Lane Day Hab, Llc

Provider IdIssuer StateIssuer TypeIssuer
856321104MissouriMedicaid

official-icon 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/PositionOWNER/ADMINISTRATOR
Authorized Official Phone Number417-867-3397