Willhaven Residential Complex, Inc.

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

N00027062 Issued in MO

Legal business name

WILLHAVEN RESIDENTIAL COMPLEX, INC.

Practice address

2698 Debbie LN
Poplar Bluff, MO 63901-2629

Phone

(573) 686-4700

NPI assigned

Mar 23, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Dairel L. Denton Jr., CPA,CFP,CFS,BCM,BCE

Title

Pres.

Phone

(573) 686-3053

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1174608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1790802916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1054",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639021054",
            "telephone_number": "573-686-4700",
            "fax_number": "573-686-1441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2698 DEBBIE LN",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639012629",
            "telephone_number": "573-686-4700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLHAVEN RESIDENTIAL COMPLEX, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DENTON",
        "authorized_official_first_name": "DAIREL",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "PRES.",
        "authorized_official_telephone_number": "573-686-3053",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "CPA,CFP,CFS,BCM,BCE"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "MO",
            "license": "N00027062",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lakeshia Nell Wilhelm
• James W Wilkerson, MD
• Tina Wilkins
• Shannon Danielle Willard
• Rebecca Lynn Willey, PHARMD
• Anthony Williams
• Jerri Ann Williams, OT
• Jim Williams, OT
• Latoya D Williams, LBA, BCBA
• Lyntoria Rochelle Williams, LCSW

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Poplar Bluff, MO
• Providers in Poplar Bluff, MO by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.