OrganizationActive
Pony Bird Incorporated
NPI 1114044815 · Intellectual and/or Developmental Disabilities Residential Treatment Facility · Mapaville, MO
Provider details
- NPI number
- 1114044815
- Entity type
- Organization
- Primary specialty
- Intellectual and/or Developmental Disabilities Residential Treatment FacilityResidential Treatment Facilities
- Organization subpart
- No
- Authorized official
- Linda Dallas, Executive Director(636) 931-5818
- License
- 1351-8421 (MO)
Specialties & taxonomies
- Intellectual and/or Developmental Disabilities Residential Treatment FacilityPrimary320600000XLicense 1351-8421 (MO)
Residential Treatment Facilities
Practice location
#1 Pony Bird Lane
Mapaville, MO 63065-0190
Phone: (636) 931-5818
Fax: (636) 931-3518
Approximate (ZIP-level) locationGet directions
Mailing address
Po Box 190
Mapaville, MO 63065-0190
Registry dates
- Enumerated
- 2007-03-26
- Last updated
- 2020-08-22
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.