Green Maxville Supportive Living LLC

NPI #1235511692 in Columbia, Missouri

Provider Information

NPI Number: 1235511692
Entity Type: Organization
Organization Name: Green Maxville Supportive Living LLC
Primary Specialty: Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Enumeration Date: Jun 22, 2015
Last Updated: Jun 22, 2015

Practice Location

Address: 101 E ALHAMBRA DR
City: Columbia
State: Missouri
ZIP Code: 65203-3763
Phone: (573) 864-9743

Authorized Official

Name: DALE A MAXVILLE JR., PHD, BCBA-D, LBA
Title: PRESIDENT/OWNER
Phone: (573) 864-9743

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Community/Behavioral Health	251S00000X
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities	320900000X	Primary

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