Provider Demographics
NPI:1124211289
Name:WILLOWS UNIFIED
Entity Type:Organization
Organization Name:WILLOWS UNIFIED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SCHOOL DISTRICT NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:A
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-934-6640
Mailing Address - Street 1:823 W LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:WILLOWS
Mailing Address - State:CA
Mailing Address - Zip Code:95988-2946
Mailing Address - Country:US
Mailing Address - Phone:530-934-6600
Mailing Address - Fax:530-934-6609
Practice Address - Street 1:823 W LAUREL ST
Practice Address - Street 2:
Practice Address - City:WILLOWS
Practice Address - State:CA
Practice Address - Zip Code:95988-2946
Practice Address - Country:US
Practice Address - Phone:530-934-6600
Practice Address - Fax:530-934-6609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASS1162661Medicaid