Provider Demographics
NPI:1558538967
Name:WILLOWS HEALTH CENTER
Entity Type:Organization
Organization Name:WILLOWS HEALTH CENTER
Other - Org Name:WESLEY WILLOWS OUTPATIENT REHAB CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:TICKNOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-316-1518
Mailing Address - Street 1:4141 N ROCKTON AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61103-1524
Mailing Address - Country:US
Mailing Address - Phone:815-316-1518
Mailing Address - Fax:
Practice Address - Street 1:4143 ALBRIGHT LANE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61103
Practice Address - Country:US
Practice Address - Phone:815-316-1518
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation