Provider Demographics
NPI:1730909037
Name:UPON THE ROCK, INC.
Entity type:Organization
Organization Name:UPON THE ROCK, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE AND PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RASHAAD
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN-PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-422-4986
Mailing Address - Street 1:1438 WELLS ST
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:MO
Mailing Address - Zip Code:65613-3510
Mailing Address - Country:US
Mailing Address - Phone:417-771-8731
Mailing Address - Fax:
Practice Address - Street 1:520 S ALBANY AVE
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613-2116
Practice Address - Country:US
Practice Address - Phone:417-771-8731
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-12
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children