Provider Demographics
NPI:1093160095
Name:WILLOW HEALTH CARE INC DBA RIVERVIEW PLACE
Entity Type:Organization
Organization Name:WILLOW HEALTH CARE INC DBA RIVERVIEW PLACE
Other - Org Name:RIVERVIEW RESIDENTIAL PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF FINANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-469-0204
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:WILLOW SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:65793-8254
Mailing Address - Country:US
Mailing Address - Phone:417-469-0204
Mailing Address - Fax:417-469-3443
Practice Address - Street 1:1200 W HALL ST
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:MO
Practice Address - Zip Code:65721-9103
Practice Address - Country:US
Practice Address - Phone:417-581-6025
Practice Address - Fax:417-581-4652
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILLOW HEALTH CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-04-27
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO263757908Medicaid