Provider Demographics
NPI:1255332086
Name:WILLOW HEALTH CARE INC
Entity Type:Organization
Organization Name:WILLOW HEALTH CARE INC
Other - Org Name:MOUNTAIN VIEW HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:417-469-3152
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:WILLOW SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:65793-0309
Mailing Address - Country:US
Mailing Address - Phone:417-469-3152
Mailing Address - Fax:417-469-5304
Practice Address - Street 1:1211 N ASH ST
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:MO
Practice Address - Zip Code:65548-7376
Practice Address - Country:US
Practice Address - Phone:417-934-6818
Practice Address - Fax:417-469-3443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO031553314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO102757101Medicaid
MO102757101Medicaid