Provider Demographics
NPI:1073069514
Name:WILLOW GROVE, INC.
Entity Type:Organization
Organization Name:WILLOW GROVE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEROY
Authorized Official - Middle Name:GILBERT
Authorized Official - Last Name:MATTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:5094-671-1135
Mailing Address - Street 1:1620 E MEAD ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-1772
Mailing Address - Country:US
Mailing Address - Phone:509-467-1135
Mailing Address - Fax:509-468-7906
Practice Address - Street 1:1620 E MEAD ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1772
Practice Address - Country:US
Practice Address - Phone:509-467-1135
Practice Address - Fax:509-468-7906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-25
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility