Wyatt House Inc

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

License

5687-9292 Issued in MO

Legal business name

WYATT HOUSE INC

Practice address

707 Wyatt Ave
Golden City, MO 64748-8300

Phone

(417) 537-4200

NPI assigned

Apr 12, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Paul D Throckmorton

Title

Ceo

Phone

(417) 537-4200

Specialties & licenses 2

Addresses

Other identifiers 1

Tax ID family

Wyatt House2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Wyatt House

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Golden City, MO
  • NPI 1902029325
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1440028800000",
    "number": "1003030727",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "707 WYATT AVE",
            "city": "GOLDEN CITY",
            "state": "MO",
            "postal_code": "647488300",
            "telephone_number": "417-537-4200",
            "fax_number": "417-537-4200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "707 WYATT AVE",
            "city": "GOLDEN CITY",
            "state": "MO",
            "postal_code": "647488300",
            "telephone_number": "417-537-4200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WYATT HOUSE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-12",
        "last_updated": "2015-08-20",
        "status": "A",
        "authorized_official_last_name": "THROCKMORTON",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "417-537-4200"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "MO",
            "license": "5687-9292",
            "primary": true
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "MO",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "852932003",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alyssa Lynn Jensen
• Debra Jean Johnson, FNP-C
• Vina Maureen Kahre
• Julitta J. Shirley, FNP
• Wyatt House

• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Golden City, MO
• Providers in Golden City, MO by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.