Organization
WILLHAVEN RESIDENTIAL COMPLEX, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAIREL L. DENTON JR. CPA,CFP,CFS,BCM,BCE (PRES.)
(573) 686-3053
Entity
Organization
Contact information
Practice address
2698 DEBBIE LN, POPLAR BLUFF, MO 63901-2629
(573) 686-4700
Mailing address
PO BOX 1054, POPLAR BLUFF, MO 63902-1054
(573) 686-4700
(573) 686-1441
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
N00027062
MO
Other
Enumeration date
03/23/2007
Last updated
08/22/2020
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