Organization
SHANAHAN ISL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DEBRA LOUIS SHANAHAN (PROVIDER)
(816) 537-7638
Entity
Organization
Contact information
Practice address
2204 GAMBRELL ST, GREENWOOD, MO 64034-9618
(816) 537-7638
(816) 537-7941
Mailing address
2204 GAMBRELL ST, GREENWOOD, MO 64034-9618
(816) 537-7638
(816) 537-7941
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Enumeration date
04/04/2007
Last updated
08/22/2020
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