Provider Demographics
NPI:1184276982
Name:WILLOW HEALTH CARE INC
Entity type:Organization
Organization Name:WILLOW HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICARE INSURANCE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-469-0204
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:WILLOW SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:65793-0309
Mailing Address - Country:US
Mailing Address - Phone:417-469-0204
Mailing Address - Fax:417-469-3443
Practice Address - Street 1:712 COPPER ROCK DR
Practice Address - Street 2:
Practice Address - City:ROGERSVILLE
Practice Address - State:MO
Practice Address - Zip Code:65742-8970
Practice Address - Country:US
Practice Address - Phone:417-469-0204
Practice Address - Fax:417-469-3443
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILLOW HEALTH CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-11
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility