Provider Demographics
NPI:1053452730
Name:MACE, ROLLAND
Entity Type:Individual
Prefix:
First Name:ROLLAND
Middle Name:
Last Name:MACE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 402
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:KS
Mailing Address - Zip Code:66035-0402
Mailing Address - Country:US
Mailing Address - Phone:785-442-3899
Mailing Address - Fax:
Practice Address - Street 1:806 W, PENNSYLVANIA ST.
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:KS
Practice Address - Zip Code:66035
Practice Address - Country:US
Practice Address - Phone:785-442-3899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities