# WILLOW CREEK ISL, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Willow Creek Group Home
- **Organization subpart:** No

## Provider details

- **NPI number:** 1538281019
- **Authorized official:** CHRISTIAN DENISON (OWNER)
- **Authorized official phone:** (816) 225-8214

## Contact information

- **Practice address:** 1008 EDITH AVE., ADRIAN, MO 64720
- **Practice address phone:** (816) 225-8214
- **Practice address fax:** (816) 297-4032
- **Mailing address:** 1008 EDITH AVE., ADRIAN, MO 64720
- **Mailing address phone:** (816) 225-8214
- **Mailing address fax:** (816) 297-4032

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | 855188900 | MO | Yes |

## Other

- **Enumeration date:** 04/04/2007
- **Last updated:** 12/03/2021