Provider Demographics
NPI:1114041886
Name:GINGERBREAD HOUSE INC
Entity Type:Organization
Organization Name:GINGERBREAD HOUSE INC
Other - Org Name:GINGERBREAD HOUSE WHITNEY
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:SACHS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:573-364-4398
Mailing Address - Street 1:101 FAIRGROUNDS RD
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401-2909
Mailing Address - Country:US
Mailing Address - Phone:573-364-4398
Mailing Address - Fax:573-364-8825
Practice Address - Street 1:1405 WHITNEY LN
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-3616
Practice Address - Country:US
Practice Address - Phone:573-364-4398
Practice Address - Fax:573-364-8825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251C00000XAgenciesDay Training, Developmentally Disabled Services
Not Answered320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities