Provider Demographics
NPI:1962458802
Name:WILLOW TREE HOSPICE LLC
Entity Type:Organization
Organization Name:WILLOW TREE HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:COLL
Authorized Official - Suffix:
Authorized Official - Credentials:RN BS
Authorized Official - Phone:610-444-8733
Mailing Address - Street 1:616 E CYPRESS ST
Mailing Address - Street 2:
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348-2470
Mailing Address - Country:US
Mailing Address - Phone:610-444-8733
Mailing Address - Fax:610-444-5003
Practice Address - Street 1:616 E CYPRESS ST
Practice Address - Street 2:
Practice Address - City:KENNETT SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19348-2470
Practice Address - Country:US
Practice Address - Phone:610-444-8733
Practice Address - Fax:610-444-5003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1017591660001Medicaid
PA1017591660001Medicaid