Provider Demographics
NPI:1952302788
Name:WILLOW HEALTH CARE INC
Entity Type:Organization
Organization Name:WILLOW HEALTH CARE INC
Other - Org Name:WILLOW HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:417-469-3152
Mailing Address - Street 1:2646 STATE ROUTE 76
Mailing Address - Street 2:PO BOX 309
Mailing Address - City:WILLOW SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:65793-8254
Mailing Address - Country:US
Mailing Address - Phone:417-469-3152
Mailing Address - Fax:417-469-3443
Practice Address - Street 1:2646 STATE ROUTE 76
Practice Address - Street 2:
Practice Address - City:WILLOW SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:65793-8254
Practice Address - Country:US
Practice Address - Phone:417-469-3152
Practice Address - Fax:417-469-3443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO031294314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO101474104Medicaid
MO101474104Medicaid
MO0342850002Medicare NSC