Healthcare Provider Details

I. General information

NPI: 1992256291
Provider Name (Legal Business Name): HILLCREST FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2016
Last Update Date: 10/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2543 WILBRICHT LN
DUBUQUE IA
52001-3034
US

IV. Provider business mailing address

2005 ASBURY RD
DUBUQUE IA
52001-3042
US

V. Phone/Fax

Practice location:
  • Phone: 563-583-7357
  • Fax:
Mailing address:
  • Phone: 563-583-7357
  • Fax: 888-243-3455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. GARY GANSEMER
Title or Position: PRESIDENT/CEO
Credential: MSW
Phone: 563-583-7357