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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