Organization
WILLOW CREEK GROUP HOME
Active
Other names
Willow Creek South Group Home
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JEANIE SUE STEPHENS (OWNER)
(816) 297-4256
Entity
Organization
Contact information
Practice address
RURAL ROUTE 2, BOX 27, ADRIAN, MO 64720
(816) 297-4256
(816) 297-8956
Mailing address
1007 OLD 71 HIGHWAY, ADRIAN, MO 64720
(816) 297-2037
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
WC2-0252-0712
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
320900000X
—
MO
Enumeration date
11/16/2012
Last updated
11/16/2012
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