Healthcare Provider Details

I. General information

NPI: 1114041886
Provider Name (Legal Business Name): GINGERBREAD HOUSE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 WHITNEY LN
ROLLA MO
65401-3616
US

IV. Provider business mailing address

101 FAIRGROUNDS RD
ROLLA MO
65401-2909
US

V. Phone/Fax

Practice location:
  • Phone: 573-364-4398
  • Fax: 573-364-8825
Mailing address:
  • Phone: 573-364-4398
  • Fax: 573-364-8825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MARIA E SACHS
Title or Position: EXECUTIVE DIRECTOR
Credential: R.N.
Phone: 573-364-4398