Organization
MILL CREEK SUPPORTIVE CARE LLC
Active
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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