| Green Maxville Supportive Living Llc | |
|
101 E Alhambra Dr Columbia MO 65203-3763 | |
| (573) 864-9743 | |
| (573) 874-1723 |
| Full Name | Green Maxville Supportive Living Llc |
|---|---|
| Speciality | Community Based Residential Treatment Facility, Intellectual And/or Developmental Disabilities |
| Location | 101 E Alhambra Dr, Columbia, Missouri |
| Authorized Official Name and Position | Dale A Maxville (PRESIDENT/OWNER) |
| Authorized Official Contact | 5738649743 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Green Maxville Supportive Living Llc 5900 Galli Ln Collinsville IL 62234-5836 Ph: (573) 864-9743 | Green Maxville Supportive Living Llc 101 E Alhambra Dr Columbia MO 65203-3763 Ph: (573) 864-9743 |
| NPI Number | 1235511692 |
|---|---|
| Provider Enumeration Date | 06/22/2015 |
| Last Update Date | 06/22/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235511692 | NPI | - | NPPES |
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