Provider Demographics
NPI:1851645675
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:
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 1:225 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-2375
Mailing Address - Country:US
Mailing Address - Phone:563-690-1239
Mailing Address - Fax:
Practice Address - Street 1:225 W 6TH ST
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-6809
Practice Address - Country:US
Practice Address - Phone:563-690-1239
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-31
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA11492OtherWELLMARK BCBS
IA0488775Medicaid