Provider Demographics
NPI:1205956794
Name:THE WILLOWS, AN ASSISTED LIVING AND ADULT DAY CARE COMMUNITY, INC.
Entity type:Organization
Organization Name:THE WILLOWS, AN ASSISTED LIVING AND ADULT DAY CARE COMMUNITY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:LESCAULT
Authorized Official - Suffix:
Authorized Official - Credentials:AS,BS,MBA,ADM,ALA
Authorized Official - Phone:401-245-2323
Mailing Address - Street 1:47 BARKER AVE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:RI
Mailing Address - Zip Code:02885-2027
Mailing Address - Country:US
Mailing Address - Phone:401-245-2323
Mailing Address - Fax:401-247-9030
Practice Address - Street 1:47 BARKER AVE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:RI
Practice Address - Zip Code:02885-2027
Practice Address - Country:US
Practice Address - Phone:401-245-2323
Practice Address - Fax:401-247-9030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI11251J00000X
261QA0600X
RI01383310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No251J00000XAgenciesNursing Care
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
RITW40442Medicaid
RITW25654Medicaid