NPIMap

Organization Active NPI

Rocky Creek Youth Ranch Incorportated

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Park Hills, MO
National Provider Identifier
1790148971
Registry record updated Apr 4, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
License
N000701465 Issued in MO
Legal business name
ROCKY CREEK YOUTH RANCH INCORPORTATED
Practice address
1286 Matthews LN
Park Hills, MO 63601-7207
Phone
(573) 562-7751
NPI assigned
Apr 4, 2016
Last updated
Apr 4, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Cliff Talley
Title
Executive Director
Phone
(573) 562-7751

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X N000701465 MO Primary

Addresses

Primary practice location

1286 Matthews LN
Park Hills, MO 63601-7207

Mailing address

1286 Matthews LN
Park Hills, MO 63601-7207

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1459728000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459728000000",
    "number": "1790148971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1286 MATTHEWS LN",
            "city": "PARK HILLS",
            "state": "MO",
            "postal_code": "636017207"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1286 MATTHEWS LN",
            "city": "PARK HILLS",
            "state": "MO",
            "postal_code": "636017207",
            "telephone_number": "573-562-7751"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROCKY CREEK YOUTH RANCH INCORPORTATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-04",
        "last_updated": "2016-04-04",
        "status": "A",
        "authorized_official_last_name": "TALLEY",
        "authorized_official_first_name": "CLIFF",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "573-562-7751"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "MO",
            "license": "N000701465",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Park Hills, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.