Organization
HICKORY HEIGHTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ANJEANETTE T ROTH (ADMINISTRATOR)
(785) 735-9236
Entity
Organization
Contact information
Practice address
1202 HICKORY ST, VICTORIA, KS 67671-9310
(785) 735-9236
Mailing address
1202 HICKORY ST, VICTORIA, KS 67671-9310
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
08/13/2008
Last updated
08/13/2008
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