Provider Demographics
NPI:1992970107
Name:RAINEY HICKS, FLORENCE DENISE
Entity type:Individual
Prefix:MRS
First Name:FLORENCE
Middle Name:DENISE
Last Name:RAINEY HICKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1024 VEGAS DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-1450
Mailing Address - Country:US
Mailing Address - Phone:573-219-1414
Mailing Address - Fax:573-256-1519
Practice Address - Street 1:1501 LAMBETH DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65202-2462
Practice Address - Country:US
Practice Address - Phone:573-219-1414
Practice Address - Fax:573-256-1915
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities