# ROCKY CREEK YOUTH RANCH INCORPORTATED

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790148971
- **Authorized official:** CLIFF TALLEY (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (573) 562-7751

## Contact information

- **Practice address:** 1286 MATTHEWS LN, PARK HILLS, MO 63601-7207
- **Practice address phone:** (573) 562-7751
- **Mailing address:** 1286 MATTHEWS LN, PARK HILLS, MO 63601-7207

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | N000701465 | MO | Yes |

## Other

- **Enumeration date:** 04/04/2016
- **Last updated:** 04/04/2016