Provider Demographics
NPI:1790883205
Name:WILLOW SPRINGS LLC
Entity Type:Organization
Organization Name:WILLOW SPRINGS LLC
Other - Org Name:WILLOW SPRINGS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VP CFO
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:FILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-738-3300
Mailing Address - Street 1:PO BOX 30012
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89520-3012
Mailing Address - Country:US
Mailing Address - Phone:775-789-4245
Mailing Address - Fax:775-789-4260
Practice Address - Street 1:690 EDISON WAY
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-4100
Practice Address - Country:US
Practice Address - Phone:775-789-4245
Practice Address - Fax:775-789-4260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X, 261QM0801X
NVGF125402227253J00000X
NV671 HO5-13323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No253J00000XAgenciesFoster Care Agency
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV006316600Medicaid