Healthcare Provider Details

I. General information

NPI: 1326172883
Provider Name (Legal Business Name): GENTRY COUNTY ASSOCIATION FOR RETARDED CITIZENS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 SOUTH ST
BETHANY MO
64424-1755
US

IV. Provider business mailing address

106 S SMITH ST
ALBANY MO
64402-1624
US

V. Phone/Fax

Practice location:
  • Phone: 660-425-6010
  • Fax:
Mailing address:
  • Phone: 660-726-4155
  • Fax: 660-726-3916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number StateMO

VIII. Authorized Official

Name: MR. ED D. MOLDENHAUER
Title or Position: EXECUTIVE DIRECTOR
Credential: MS
Phone: 660-726-4155