Provider Demographics
NPI:1376094383
Name:WILLOW BROOK CHRISTIAN SERVICES
Entity Type:Organization
Organization Name:WILLOW BROOK CHRISTIAN SERVICES
Other - Org Name:WILLOW BROOK BY DAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:NEILL
Authorized Official - Last Name:POULSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-201-5671
Mailing Address - Street 1:100 DELAWARE XING W
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-7853
Mailing Address - Country:US
Mailing Address - Phone:740-201-5640
Mailing Address - Fax:740-201-5670
Practice Address - Street 1:100 WILLOW BROOK WAY S
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-3249
Practice Address - Country:US
Practice Address - Phone:740-369-5447
Practice Address - Fax:740-369-7034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-14
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care