Organization
ROCKY CREEK YOUTH RANCH INCORPORTATED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CLIFF TALLEY (EXECUTIVE DIRECTOR)
(573) 562-7751
Entity
Organization
Contact information
Practice address
1286 MATTHEWS LN, PARK HILLS, MO 63601-7207
(573) 562-7751
Mailing address
1286 MATTHEWS LN, PARK HILLS, MO 63601-7207
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
N000701465
MO
Other
Enumeration date
04/04/2016
Last updated
04/04/2016
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