Colonial House of Crystal City, LLC
NPI #1962644401 in Crystal City, Missouri
Provider Information
- NPI Number
- 1962644401
- Entity Type
- Organization
- Organization Name
- Colonial House of Crystal City, LLC
- Primary Specialty
- Residential Treatment Facility, Intellectual and/or Developmental Disabilities
- Enumeration Date
- Mar 30, 2009
- Last Updated
- Mar 30, 2009
Practice Location
- Address
- 26 MISSISSIPPI AVE
- City
- Crystal City
- State
- Missouri
- ZIP Code
- 63019-1817
- Phone
- (636) 937-1000
Authorized Official
- Name
- MRS. ALYSHA LYNN SAUER
- Title
- MEMBER
- Phone
- (636) 933-4911
Specialties & Taxonomy Codes
| Specialty |
|---|
| Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
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