Provider Demographics
NPI:1518390145
Name:WILLOW HOSPICE AND PALLIATIVE CARE, LLC
Entity Type:Organization
Organization Name:WILLOW HOSPICE AND PALLIATIVE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HERMINIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANABAT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:815-508-5253
Mailing Address - Street 1:13246 S ROUTE 59 STE 102
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585-9801
Mailing Address - Country:US
Mailing Address - Phone:815-230-3910
Mailing Address - Fax:815-230-3930
Practice Address - Street 1:13246 S ROUTE 59 STE 102
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60585-9801
Practice Address - Country:US
Practice Address - Phone:815-230-3910
Practice Address - Fax:815-230-3930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-19
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2003105251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based