Provider Demographics
NPI:1073250098
Name:WILLOW BEND HOME CARE
Entity Type:Organization
Organization Name:WILLOW BEND HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:NDUMBI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-685-6258
Mailing Address - Street 1:120 E FM 544 # 517
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:TX
Mailing Address - Zip Code:75094-4034
Mailing Address - Country:US
Mailing Address - Phone:469-685-6258
Mailing Address - Fax:
Practice Address - Street 1:120 E FM 544 # 517
Practice Address - Street 2:
Practice Address - City:MURPHY
Practice Address - State:TX
Practice Address - Zip Code:75094-4034
Practice Address - Country:US
Practice Address - Phone:469-685-6258
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-19
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care