Provider Demographics
NPI:1609991587
Name:GREATER HEIGHTS ADHC, LLC
Entity Type:Organization
Organization Name:GREATER HEIGHTS ADHC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:GREENWALT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-431-0344
Mailing Address - Street 1:719 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-1925
Mailing Address - Country:US
Mailing Address - Phone:573-756-7554
Mailing Address - Fax:573-756-0227
Practice Address - Street 1:719 MAPLE ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-1925
Practice Address - Country:US
Practice Address - Phone:573-756-7554
Practice Address - Fax:573-756-0227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO6208-9056251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO292756905Medicaid