Provider Demographics
NPI:1548420920
Name:WILLOW, LLC
Entity Type:Organization
Organization Name:WILLOW, LLC
Other - Org Name:WILLOW MEDICAL AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EILLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-632-7577
Mailing Address - Street 1:1407 W 31ST AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-3678
Mailing Address - Country:US
Mailing Address - Phone:907-632-7577
Mailing Address - Fax:907-522-4557
Practice Address - Street 1:920 E 72ND AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99518-2810
Practice Address - Country:US
Practice Address - Phone:907-632-7577
Practice Address - Fax:907-522-4557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK50892084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty