Provider Demographics
NPI:1265510655
Name:WILLOWOOD OF GREAT BARRINGTON INC
Entity Type:Organization
Organization Name:WILLOWOOD OF GREAT BARRINGTON INC
Other - Org Name:FAIRVIEW COMMONS NURSING AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:JONES
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:413-447-2996
Mailing Address - Street 1:151 CHRISTIAN HILL RD
Mailing Address - Street 2:
Mailing Address - City:GREAT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230-1108
Mailing Address - Country:US
Mailing Address - Phone:413-528-4560
Mailing Address - Fax:413-528-5691
Practice Address - Street 1:151 CHRISTIAN HILL RD
Practice Address - Street 2:
Practice Address - City:GREAT BARRINGTON
Practice Address - State:MA
Practice Address - Zip Code:01230-1108
Practice Address - Country:US
Practice Address - Phone:413-528-4560
Practice Address - Fax:413-528-5691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0821314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00968507Medicaid
NY00508723Medicaid
MA0930156Medicaid
MA0925675Medicaid
MA1905295Medicaid
MA1905295Medicaid
NY00508723Medicaid