Provider Demographics
NPI:1932138823
Name:WILLOUGH HEALTHCARE, INC
Entity Type:Organization
Organization Name:WILLOUGH HEALTHCARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:PICCIANO
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:239-775-4500
Mailing Address - Street 1:9001 TAMIAMI TRL E
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34113-3304
Mailing Address - Country:US
Mailing Address - Phone:239-775-4500
Mailing Address - Fax:239-755-2990
Practice Address - Street 1:9001 TAMIAMI TRL E
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34113-3304
Practice Address - Country:US
Practice Address - Phone:239-775-4500
Practice Address - Fax:239-755-2990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4212283Q00000X
FL821894323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104063Medicare Oscar/Certification