Organization
WILLOW CREEK ISL, LLC
Active
Organization
WILLOW CREEK ISL, LLC
Active
Other names
Willow Creek Group Home South
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTIAN DENNISON (OWNER)
(816) 225-8214
Entity
Organization
Contact information
Practice address
1008 EDITH AVE., ADRIAN, MO 64720
(816) 225-8214
(816) 297-8956
Mailing address
1008 EDITH AVE., ADRIAN, MO 64720
(816) 225-8214
(816) 297-8956
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
134112203
MO
Other
Enumeration date
01/03/2011
Last updated
01/28/2022
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