Provider Demographics
NPI:1609835990
Name:WILLOW SPRINGS CARE
Entity Type:Organization
Organization Name:WILLOW SPRINGS CARE
Other - Org Name:WILLOW SPRINGS CARE AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:RANDALL
Authorized Official - Last Name:HYATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-248-7379
Mailing Address - Street 1:4007 TIETON DRIVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-3345
Mailing Address - Country:US
Mailing Address - Phone:509-966-4500
Mailing Address - Fax:509-966-1187
Practice Address - Street 1:4007 TIETON DRIVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-3345
Practice Address - Country:US
Practice Address - Phone:509-966-4500
Practice Address - Fax:509-966-1187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANH 983314000000X
WA1392314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1014388Medicaid
WA4113924Medicaid
505367Medicare Oscar/Certification
WA1014388Medicaid