Organization
WILLOW CREEK ISL, LLC
Active
Other names
Willow Creek Group Home
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTIAN DENISON (OWNER)
(816) 225-8214
Entity
Organization
Contact information
Practice address
1008 EDITH AVE., ADRIAN, MO 64720
(816) 225-8214
(816) 297-4032
Mailing address
1008 EDITH AVE., ADRIAN, MO 64720
(816) 225-8214
(816) 297-4032
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
855188900
MO
Other
Enumeration date
04/04/2007
Last updated
12/03/2021
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