Organization
MCWILLIAMS MANOR, INCORPORATED
Active
Parent organization
MCWILLIAMS MANOR, INCORPORATED
Other names
dba McWilliams Manor ISL
Organization subpart
Yes
Provider details
NPI number
Legal business name
MCWILLIAMS MANOR, INCORPORATED
Authorized official
MRS. PATRICIA L WESTOVER-MCWILLIAMS MRN (OWNER)
(573) 727-9760
Entity
Organization
Contact information
Practice address
3439 S WESTWOOD BLVD, POPLAR BLUFF, MO 63901-8670
(573) 727-9760
(573) 727-9760
Mailing address
3439 S WESTWOOD BLVD, POPLAR BLUFF, MO 63901-8670
(573) 727-9760
(573) 727-9760
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
8001561
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
858524713
—
MO
Enumeration date
03/14/2007
Last updated
02/17/2017
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