Provider Demographics
NPI:1003069485
Name:WILLOW SPRINGS LLC
Entity Type:Organization
Organization Name:WILLOW SPRINGS LLC
Other - Org Name:WILLOW SPRINGS OUTPATIENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MISS
Authorized Official - First Name:SABRINA
Authorized Official - Middle Name:D
Authorized Official - Last Name:PATTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-858-4536
Mailing Address - Street 1:PO BOX 30012
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89520-3012
Mailing Address - Country:US
Mailing Address - Phone:775-789-4274
Mailing Address - Fax:775-789-4260
Practice Address - Street 1:650 EDISON WAY
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-4100
Practice Address - Country:US
Practice Address - Phone:775-284-4717
Practice Address - Fax:775-284-4595
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILLOW SPRINGS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-29
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100510853Medicaid