NPIMap

Organization Active NPI

Willow Creek Isl, LLC

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Adrian, MO
National Provider Identifier
1871897017
Registry record updated Jan 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X
License
134112203 Issued in MO
Legal business name
WILLOW CREEK ISL, LLC
Practice address
1008 Edith Ave.
Adrian, MO 64720
Phone
(816) 225-8214
Fax
(816) 297-8956
NPI assigned
Jan 3, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2022

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

Authorized official

Name
Christian Dennison
Title
Owner
Phone
(816) 225-8214

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X 134112203 MO Primary

Addresses

Primary practice location

1008 Edith Ave.
Adrian, MO 64720

Mailing address

1008 Edith Ave.
Adrian, MO 64720
Phone (816) 225-8214

Other names 1

  • Willow Creek Group Home South Other name

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1294012800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643328000000",
    "number": "1871897017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1008 EDITH AVE.",
            "city": "ADRIAN",
            "state": "MO",
            "postal_code": "64720",
            "telephone_number": "816-225-8214",
            "fax_number": "816-297-8956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1008 EDITH AVE.",
            "city": "ADRIAN",
            "state": "MO",
            "postal_code": "64720",
            "telephone_number": "816-225-8214",
            "fax_number": "816-297-8956"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOW CREEK ISL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-03",
        "last_updated": "2022-01-28",
        "certification_date": "2022-01-28",
        "status": "A",
        "authorized_official_last_name": "DENNISON",
        "authorized_official_first_name": "CHRISTIAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "816-225-8214"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "MO",
            "license": "134112203",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Willow Creek Group Home South",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Willow Creek Group Home South",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Adrian, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2022; 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.