Organization
WYATT HOUSE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL D THROCKMORTON (CEO)
(417) 537-4200
Entity
Organization
Contact information
Practice address
707 WYATT AVE, GOLDEN CITY, MO 64748-8300
(417) 537-4200
Mailing address
707 WYATT AVE, GOLDEN CITY, MO 64748-8300
(417) 537-4200
(417) 537-4200
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
5687-9292
MO
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
852932003
—
MO
Enumeration date
04/12/2007
Last updated
08/20/2015
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