Provider Demographics
NPI:1790360253
Name:WILLOW HOSPICE CARE LLC
Entity Type:Organization
Organization Name:WILLOW HOSPICE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-793-3227
Mailing Address - Street 1:20534 SAM HOUSTON BLVD
Mailing Address - Street 2:
Mailing Address - City:RIO HONDO
Mailing Address - State:TX
Mailing Address - Zip Code:78583-2104
Mailing Address - Country:US
Mailing Address - Phone:956-793-3227
Mailing Address - Fax:
Practice Address - Street 1:20534 SAM HOUSTON BLVD
Practice Address - Street 2:
Practice Address - City:RIO HONDO
Practice Address - State:TX
Practice Address - Zip Code:78583-2104
Practice Address - Country:US
Practice Address - Phone:956-793-3227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based