WYATT HOUSE INC NPI 1003030727

Residential Treatment Facility, Intellectual and/or Developmental Disabilities in Golden City, MO

NPI 1003030727 Organization Residential Treatment Facility, Intellec...

About WYATT HOUSE INC

Wyatt House Inc is a provider established in Golden City, Missouri specializing in residential treatment facility, intellectual and/or developmental disabilities. The NPI number of Wyatt House Inc is 1003030727 and was assigned on April 2007. The practitioner's primary taxonomy code is 320600000X with license number 5687-9292 (MO). The provider is registered as an organization and their NPI record was last updated 6 years ago. The authorized official of this NPI record is Paul D Throckmorton (Ceo)

NPI

1003030727

Provider NameWYATT HOUSE INC
Provider Location Address707 WYATT AVE GOLDEN CITY, MO 64748
Provider Mailing Address707 WYATT AVE GOLDEN CITY, MO 64748
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?No
Enumeration Date04-12-2007
Last Update Date08-20-2015


Primary Taxonomy

Taxonomy Code320600000X
ClassificationResidential Treatment Facility, Intellectual and/or Developmental Disabilities
TypeResidential Treatment Facilities
License No.5687-9292
License StateMO
Taxonomy DescriptionA residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental and intellectual disabilities and are not able to live independently.

Business Address

WYATT HOUSE INC
707 WYATT AVE
GOLDEN CITY, MO
ZIP 64748
Phone: (417) 537-4200

Get Directions


Mailing Address

WYATT HOUSE INC
707 WYATT AVE
GOLDEN CITY, MO
ZIP 64748
Phone: (417) 537-4200
Fax: (417) 537-4200



Authorized Official

Authorized Official Name PAUL D THROCKMORTON
Authorized Official TitleCEO
Authorized Official Phone(417) 537-4200

Secondary Taxonomies


The secondary taxonomy codes define the provider type, classification, and specialization. For individual NPIs the license data is associated to each taxonomy code.

No. Taxonomy Code Type Classification Specialization License No. State Primary
1320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental DisabilitiesMONo

Taxonomy Description: a home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities.

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
852932003MEDICAID (05)MO

Other Providers at the same location


The following provider is registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1902029325WYATT HOUSE
Organization
Residential Treatment Facility, Intellectual and/or Developmental Disabilities707 WYATT AVE
GOLDEN CITY, MO 64748
(417) 537-8858

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.