Provider Demographics
NPI:1598746539
Name:WILLOWBROOK FOUNDATION
Entity Type:Organization
Organization Name:WILLOWBROOK FOUNDATION
Other - Org Name:WILLOWBROOK VISITING NURSE ASSOCIATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:F
Authorized Official - Last Name:WOLFORD
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:901-276-8300
Mailing Address - Street 1:2600 THOUSAND OAKS BLVD
Mailing Address - Street 2:SUITE 2400
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38118-2466
Mailing Address - Country:US
Mailing Address - Phone:901-276-8300
Mailing Address - Fax:901-276-0286
Practice Address - Street 1:2600 THOUSAND OAKS BLVD
Practice Address - Street 2:SUITE 2400
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38118-2466
Practice Address - Country:US
Practice Address - Phone:901-276-8300
Practice Address - Fax:901-276-0286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-08
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000244251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN447006Medicare ID - Type UnspecifiedPROVIDER