Brookside Casa Isl
NPI #1740474600 in Versailles, Missouri
Provider Information
- NPI Number
- 1740474600
- Entity Type
- Organization
- Organization Name
- Brookside Casa Isl
- Primary Specialty
- Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
- Enumeration Date
- Sep 4, 2007
- Last Updated
- Sep 4, 2007
Practice Location
- Address
- 506 BREMOND ST
- City
- Versailles
- State
- Missouri
- ZIP Code
- 65084-1122
- Phone
- (573) 378-2462
Authorized Official
- Name
- MS. DENISE LYNN SPOTILA
- Title
- OWNER
- Phone
- (573) 378-2462
Specialties & Taxonomy Codes
| Specialty |
|---|
| Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
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