Provider Demographics
NPI:1821434739
Name:WILLOW PLACE II, INC
Entity Type:Organization
Organization Name:WILLOW PLACE II, INC
Other - Org Name:WILLOW PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:QA MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:CIFUENTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-707-0532
Mailing Address - Street 1:30 GARFIELD ST STE A
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-7301
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:30 GARFIELD ST STE A
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-7301
Practice Address - Country:US
Practice Address - Phone:828-254-3484
Practice Address - Fax:828-254-3485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-18
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-011-366324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility