Provider Demographics
NPI:1366786246
Name:ROLLING HILLS RESIDENTIAL CARE FACILITY, LLC
Entity type:Organization
Organization Name:ROLLING HILLS RESIDENTIAL CARE FACILITY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LLC MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:A
Authorized Official - Last Name:STOVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-265-4591
Mailing Address - Street 1:24583 HIGHWAY 5
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:MO
Mailing Address - Zip Code:63556-2809
Mailing Address - Country:US
Mailing Address - Phone:660-265-4391
Mailing Address - Fax:660-265-1070
Practice Address - Street 1:24583 HWY 5
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:MO
Practice Address - Zip Code:63556
Practice Address - Country:US
Practice Address - Phone:660-265-4391
Practice Address - Fax:660-265-1070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0406663104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness