WILLOW CREEK GROUP HOME (NPI# 1871897017) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1871897017 |
Entity Type | Organization |
Organization Name | WILLOW CREEK GROUP HOME |
Other Organization Name | WILLOW CREEK GROUP HOME SOUTH |
Practice Address |
Rte. 2, Box 27 501 Baker Street Adrian MO 64720 |
Practice Telephone | 8162974256 |
Practice Fax Number | 8162978956 |
Mailing Telephone | 8162974256 |
Mailing Fax Number | 8162978956 |
Enumeration Date | 2011-01-03 |
Last Update Date | 2011-01-03 |
Authorized Official Name | MRS. JEANIE SUE STEPHENS (OWNER) |
Authorized Official Telephone | 8162974256 |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 320900000X | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 134112203 | MO | Residential Treatment Facilities |
Other Name | Type Code |
---|---|
Willow Creek Group Home South | Other Name - Individual/Organization |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1942544820 | Willow Creek Group Home | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | Rural Route 2, Box 27, Adrian, MO 64720 | 2012-11-16 |
Entity Type | Entity Name | Entity Address |
---|---|---|
Oregon Corporations, Companies and Business Names | WILLOW CREEK GROUP HOME LLC | 1113 Icel Ct Ne, Salem, OR 97301 |
Street Address |
RTE. 2, BOX 27 501 BAKER STREET |
City | ADRIAN |
State | MO |
Zip Code | 64720 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1942544820 | Willow Creek Group Home | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | Rural Route 2, Box 27, Adrian, MO 64720 | 2012-11-16 |
1477659779 | Adrian Kreisler Drug Inc. | Durable Medical Equipment & Medical Supplies | 21 E Main St., Adrian, MO 64720 | 2006-09-15 |
1538187711 | Adrian Clinic, LLC | Nurse Practitioner | 57 East Main Street, Adrian, MO 64720 | 2006-07-17 |
1316941826 | Laura J Thiem | Nurse Practitioner | 57 East Main, Adrian, MO 64720 | 2005-06-13 |
1578797494 | Bates County Memorial Hospital | Family Medicine | 102 E. Main, Adrian, MO 64720 | 2009-05-06 |
1407046618 | Bates County Memorial Hospital | Clinic/Center | 102 E. Main, Adrian, MO 64720 | 2007-07-25 |
1568532265 | James Chandler Womelduff Iv | Chiropractor | 33 E Main St, Adrian, MO 64720 | 2006-11-09 |
1720635444 | Deborah Lovnne Beard | Technician | 14540 Nw County Road 1001, Adrian, MO 64720-4833 | 2019-08-19 |
1992285878 | Hannah Elizabeth Clayton | Behavior Technician | 15415 Nw State Route Aa, Adrian, MO 64720-4890 | 2018-08-20 |
1609387240 | Tammy Michelle Stone | Assisted Living Facility | 431 Ne County Road 10564, Adrian, MO 64720-5111 | 2017-10-23 |
Find all providers in zip 64720 |
Taxonomy Code | 320900000X |
Grouping | Residential Treatment Facilities |
Classification | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. |
Notes: [7/1/2003: new] |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1942544820 | Willow Creek Group Home | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | Rural Route 2, Box 27, Adrian, MO 64720 | 2012-11-16 |
1124162227 | Christine Lynn Bohannon | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | Box 64 303 W Main St, Adrian, MO 64720-9217 | 2007-02-20 |
1922141068 | Willow Creek Group Home, Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | Rr 2 Box 27, Adrian, MO 64720-9587 | 2007-02-15 |
1255804472 | Four Seasons of Adrian, LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 303 W Main St, Adrian, MO 64720-9217 | 2019-01-10 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1609475516 | Brandi Janelle Hickman | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 8706 Newton Ave Apt 4101, Kansas City, MO 64138-5461 | 2020-10-21 |
1154935112 | Overcomers Counseling Center Inc | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 17101 East 203rd St, Peculiar, MO 64078 | 2020-09-06 |
1386265965 | Candace Palmer | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 2405 Bowe Ln, Jefferson City, MO 65109-9116 | 2020-05-05 |
1902426596 | Matt Ferguson | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 4480 Bradley Dr, Joplin, MO 64804-5503 | 2020-04-23 |
1689206211 | Insight Industry LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 2501 Ne Prairie Falcon Dr, Blue Springs, MO 64014-1958 | 2020-02-11 |
1598306904 | Hearo Technologies LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 405 N Jefferson Ave Ste 1063, Springfield, MO 65806-1110 | 2019-10-07 |
1437790219 | Darin Roark | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 2628 Se Kimbrough Ln, Lees Summit, MO 64063-1082 | 2019-10-03 |
1942851399 | Wyatt's Dream Center | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 205 State Highway Aa, Sikeston, MO 63801-5303 | 2019-09-26 |
1043871908 | Cura Personalis, (care for The Whole Person), LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 11650 Bobwhite Road, Carthage, MO 64836 | 2019-06-21 |
1043870181 | Rebuild Contracting LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1783 Possum Hollow Dr, Camdenton, MO 65020-6709 | 2019-06-20 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.