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Pony Bird Incorporated

Residential Treatment Facility, Intellectual and/or Developmental Disabilities in Mapaville, MO. Organization (NPI-2).

NPI number1396865713
StatusActive
Last updated in NPPESAug 22, 2020

Details

NPI
1396865713
Entity type
Organization (NPI-2)
Legal business name
Pony Bird Incorporated
Organization subpart
No
Enumeration date
Mar 30, 2007
Last updated
Aug 22, 2020

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities1351-8421MOYes

Practice location

#1 Pony Bird Lane
Mapaville, MO 63065-0190

Phone 636-931-5818 · Fax 636-931-3518

Mailing address

Po Box 190
Mapaville, MO 63065-0190

Phone 636-931-5818

Authorized official

Linda M Dallas
Executive Director
6369315818

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