Provider Demographics
NPI:1497177729
Name:HILLCREST FAMILY SERVICES
Entity Type:Organization
Organization Name:HILLCREST FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:GANSEMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-583-7357
Mailing Address - Street 1:220 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:WAPELLO
Mailing Address - State:IA
Mailing Address - Zip Code:52653-1202
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:218 N 2ND ST
Practice Address - Street 2:
Practice Address - City:WAPELLO
Practice Address - State:IA
Practice Address - Zip Code:52653-1202
Practice Address - Country:US
Practice Address - Phone:319-527-4455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-06
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health