Provider Demographics
NPI:1831213925
Name:ROLLING HILLS CREATIVE LIVING, INC
Entity type:Organization
Organization Name:ROLLING HILLS CREATIVE LIVING, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
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:P O BOX 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:660-726-4155
Practice Address - Street 1:2404 ALLEN AVE
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:MO
Practice Address - Zip Code:64424-1334
Practice Address - Country:US
Practice Address - Phone:660-425-7025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO859884900Medicaid