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Gracie Lane Day Hab, Llc
Respite Care in Koshkonong, Missouri
NPI 1881055812

Gracie Lane Day Hab, Llc is a Respite Care based in Koshkonong, MO. Gracie Lane Day Hab, Llc practices in Koshkonong, MO. The NPI Number for Gracie Lane Day Hab, Llc is 1881055812 and holds a License No. CC03100514 (Missouri).

The current practice location address for Gracie Lane Day Hab, Llc is Rr 81 Box 175, Koshkonong, MO and can be reached out via phone at 417-867-3397 and via fax at 417-867-3367.

Location: Rr 81 Box 175, Koshkonong, MO, 65692-8004
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1881055812
Provider Name
Gracie Lane Day Hab, Llc
Credential
Provider Entity Type
Organization
Address
Rr 81 Box 175, Koshkonong, MO, 65692-8004
Phone Number
417-867-3397
Fax Number
417-867-3367
Provider Enumeration Date
03/18/2016
Last Update Date
03/13/2024
tick
Provider's Legacy Identifiers
Identifier Type State Issuer
856321104 05 MO
institution
Provider Business Practice Location Address Details
Address
Rr 81 Box 175
City
Koshkonong
State
Missouri
Zip
65692-8004
Phone Number
417-867-3397
Fax Number
417-867-3367
person
Provider Business Mailing Address Details
Address
Rr 81 Box 175
City
Koshkonong
State
Missouri
Zip
65692-8004
Phone Number
417-867-3397
Fax Number
417-867-3367
person
Provider's Taxonomy Details 1
Type
Residential Treatment Facilities
Classification
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Speciality
-
Taxonomy
320900000X
License No.
CC03100514 (Missouri)
Definition
A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with intellectual and/or developmental disabilities.
person
Provider's Taxonomy Details 2
Type
Respite Care Facility
Classification
Respite Care
Speciality
-
Taxonomy
385H00000X
License No.
CC03100514 (Missouri)
Definition
Definition to come.
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