Boone Supported Living, LLC

NPI #1568680403 in Hannibal, Missouri

Provider Information

NPI Number: 1568680403
Entity Type: Organization
Organization Name: Boone Supported Living, LLC
Primary Specialty: Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Enumeration Date: Apr 24, 2007
Last Updated: Aug 22, 2020

Practice Location

Address: 5 MARSH CIR
City: Hannibal
State: Missouri
ZIP Code: 63401-2479
Phone: (573) 406-8010

Authorized Official

Name: JULIE WALDEN
Title: MEMBER
Phone: (573) 406-8010

Specialties & Taxonomy Codes

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

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