Provider Demographics
NPI:1528192721
Name:GENTRY COUNTY ASSOCIATION FOR RETARDED CITIZENS
Entity Type:Organization
Organization Name:GENTRY COUNTY ASSOCIATION FOR RETARDED CITIZENS
Other - Org Name:ROLLING HILLS CREATIVE LIVING, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ED
Authorized Official - Middle Name:D
Authorized Official - Last Name:MOLDENHAUER
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:660-726-4155
Mailing Address - Street 1:106 S SMITH ST
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:MO
Mailing Address - Zip Code:64402-1624
Mailing Address - Country:US
Mailing Address - Phone:660-726-4155
Mailing Address - Fax:660-726-3916
Practice Address - Street 1:901 N CASE ST
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:MO
Practice Address - Zip Code:64402-1398
Practice Address - Country:US
Practice Address - Phone:660-726-5280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO320900000X, 332BC3200X, 385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Not Answered332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Not Answered385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child