Organization
MILL CREEK SUPPORTIVE CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY DENIECE O'NEILL RPH (EXECUTIVE DIRECTOR)
(417) 331-6990
Entity
Organization
Contact information
Practice address
220 MONROE ST, THAYER, MO 65791-1511
(417) 264-6161
(417) 264-6162
Mailing address
220 MONROE ST, THAYER, MO 65791-1511
(417) 264-6161
(417) 264-6162
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
385H00000X
Respite Care
—
—
Other
Enumeration date
12/21/2022
Last updated
12/29/2022
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