Provider Demographics
NPI:1679695324
Name:RED RIVER HOMES
Entity Type:Organization
Organization Name:RED RIVER HOMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACQUELIN
Authorized Official - Middle Name:RACHEAL
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-200-2268
Mailing Address - Street 1:RR 2 BOX 226
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:MO
Mailing Address - Zip Code:64730-9515
Mailing Address - Country:US
Mailing Address - Phone:660-200-2268
Mailing Address - Fax:
Practice Address - Street 1:RR 2 BOX 226
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:MO
Practice Address - Zip Code:64730-9515
Practice Address - Country:US
Practice Address - Phone:660-200-2268
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities