Organization
WYATT HOUSE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL D THROCKMORTON (DIRECTOR)
(417) 537-8858
Entity
Organization
Contact information
Practice address
707 WYATT AVE, GOLDEN CITY, MO 64748-8300
(417) 537-8858
(417) 537-4203
Mailing address
707 WYATT AVE, PO BOX 459, GOLDEN CITY, MO 64748-8300
(417) 537-8858
(417) 537-4203
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
5687-9292
MO
Other
Enumeration date
04/11/2007
Last updated
08/22/2020
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