Willow Creek Group Home

Primary specialty

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

License

WC2-0252-0712 Issued in MO

Legal business name

WILLOW CREEK GROUP HOME

Practice address

Rural Route 2, Box 27
Adrian, MO 64720

Phone

(816) 297-4256

Fax

(816) 297-8956

NPI assigned

Nov 16, 2012

Last updated

Nov 16, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Jeanie Sue Stephens

Title

Owner

Phone

(816) 297-4256

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Willow Creek South Group Home Other name

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

{
    "created_epoch": "1353024000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1353024000000",
    "number": "1942544820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1007 OLD 71 HIGHWAY",
            "city": "ADRIAN",
            "state": "MO",
            "postal_code": "64720",
            "telephone_number": "816-297-2037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "RURAL ROUTE 2, BOX 27",
            "city": "ADRIAN",
            "state": "MO",
            "postal_code": "64720",
            "telephone_number": "816-297-4256",
            "fax_number": "816-297-8956"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOW CREEK GROUP HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-16",
        "last_updated": "2012-11-16",
        "status": "A",
        "authorized_official_last_name": "STEPHENS",
        "authorized_official_first_name": "JEANIE",
        "authorized_official_middle_name": "SUE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "816-297-4256",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "MO",
            "license": "WC2-0252-0712",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "320900000X",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Willow Creek South Group Home",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Debra Jean Stuntebeck
• The Baptist Home (Baptist Homes of Adrian)
• Laura J Thiem, RN, FNP-BC, CNS-BC
• Georgia Underwood
• Liberty D Underwood, PTA
• Willow Creek Group Home, Inc.
• Willow Creek Isl
• Willow Creek Isl, LLC (Willow Creek Group Home)
• Willow Creek Isl, LLC
• James Chandler Womelduff IV, DC

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Adrian, MO
• Providers in Adrian, 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 Nov 16, 2012; 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.