Provider Demographics
NPI:1790176881
Name:WILLOW HEALTH CARE INC
Entity Type:Organization
Organization Name:WILLOW HEALTH CARE INC
Other - Org Name:PARK PLACE APARTMENTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-469-0204
Mailing Address - Street 1:PO BOX 879
Mailing Address - Street 2:1211 N ASH
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:MO
Mailing Address - Zip Code:65548-0879
Mailing Address - Country:US
Mailing Address - Phone:417-934-6818
Mailing Address - Fax:
Practice Address - Street 1:1211 N ASH
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:MO
Practice Address - Zip Code:65548
Practice Address - Country:US
Practice Address - Phone:417-934-6818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILLOW HEALTH CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-02-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO042811310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility