Provider Demographics
NPI:1992256291
Name:HILLCREST FAMILY SERVICES
Entity type:Organization
Organization Name:HILLCREST FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:GANSEMER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:563-583-7357
Mailing Address - Street 1:2005 ASBURY RD
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-3042
Mailing Address - Country:US
Mailing Address - Phone:563-583-7357
Mailing Address - Fax:888-243-3455
Practice Address - Street 1:2543 WILBRICHT LN
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-3034
Practice Address - Country:US
Practice Address - Phone:563-583-7357
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-21
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children