Provider Demographics
NPI:1275679953
Name:RONALD J HICKEN
Entity Type:Organization
Organization Name:RONALD J HICKEN
Other - Org Name:PARKVIEW GROUP HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BELINDA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:HICKEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-827-3032
Mailing Address - Street 1:32613 VAN DYKE RD
Mailing Address - Street 2:
Mailing Address - City:SMITHTON
Mailing Address - State:MO
Mailing Address - Zip Code:65350-3630
Mailing Address - Country:US
Mailing Address - Phone:660-827-3032
Mailing Address - Fax:660-827-5621
Practice Address - Street 1:32613 VAN DYKE RD
Practice Address - Street 2:
Practice Address - City:SMITHTON
Practice Address - State:MO
Practice Address - Zip Code:65350-3630
Practice Address - Country:US
Practice Address - Phone:660-827-3032
Practice Address - Fax:660-827-5621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1531-8325320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO853704906Medicaid