WILLOW CREEK ISL, LLC – NPI #1871897017
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities

A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with intellectual and/or developmental disabilities.

Health Care Provider Taxonomy Code for Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities

WILLOW CREEK ISL, LLC is a community based residential treatment facility located in ADRIAN, MO. NPPES has assigned the NPI number 1871897017 to WILLOW CREEK ISL, LLC on January 03, 2011. It is a Type-2 NPI, indicating this NPI number is associated with an organization. WILLOW CREEK ISL, LLC is also known by the name WILLOW CREEK GROUP HOME SOUTH. The primary taxonomy selected by this provider is 320900000X from the Health Care Provider Taxonomy code set, which is classified as Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities.

The NPI profile was previously updated about 4 years ago on Jan 28, 2022. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for WILLOW CREEK ISL, LLC below.

NPI Profile for
WILLOW CREEK ISL, LLC

NPI Number
1871897017
Enumeration Date

(more than 15 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
WILLOW CREEK ISL, LLC
Other Name: WILLOW CREEK GROUP HOME SOUTH
Primary location
1008 EDITH AVE.
ADRIAN, MO 64720
Phone: (816) 225-8214 Fax: (816) 297-8956
Mailing address
Same as primary location
Organization Subpart
No
Authorized Official
CHRISTIAN DENNISON
OWNER
Phone: (816) 225-8214
Updated
Certification Date
Jan 28, 2022

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
320900000X
- Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Primary)		 MO 134112203

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.