Provider Demographics
NPI:1710202700
Name:WILLOW WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:WILLOW WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:SINGER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:740-707-1581
Mailing Address - Street 1:4773 CARROLL CEMETERY ROAD
Mailing Address - Street 2:
Mailing Address - City:CARROLL
Mailing Address - State:OH
Mailing Address - Zip Code:43112
Mailing Address - Country:US
Mailing Address - Phone:740-707-1581
Mailing Address - Fax:
Practice Address - Street 1:4773 CARROLL CEMETERY ROAD
Practice Address - Street 2:
Practice Address - City:CARROLL
Practice Address - State:OH
Practice Address - Zip Code:43112
Practice Address - Country:US
Practice Address - Phone:740-707-1581
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-01
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34008863261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSI4215331Medicare UPIN