Provider Demographics
NPI:1083890958
Name:WILLOWTREE ISL
Entity Type:Organization
Organization Name:WILLOWTREE ISL
Other - Org Name:LORRIE R. NEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORRIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:NEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-875-7819
Mailing Address - Street 1:5015 S COWAN LOOP
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-9781
Mailing Address - Country:US
Mailing Address - Phone:573-875-7819
Mailing Address - Fax:
Practice Address - Street 1:5015 S COWAN LOOP
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-9781
Practice Address - Country:US
Practice Address - Phone:573-875-7819
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities