Provider Demographics
NPI:1205982303
Name:THE INN AT WILLOW FALLS
Entity type:Organization
Organization Name:THE INN AT WILLOW FALLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:S
Authorized Official - Last Name:GOODE
Authorized Official - Suffix:
Authorized Official - Credentials:RN,C,MS
Authorized Official - Phone:815-725-5868
Mailing Address - Street 1:1681 WILLOW CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:CREST HILL
Mailing Address - State:IL
Mailing Address - Zip Code:60435-2062
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:815-728-5853
Practice Address - Street 1:1681 WILLOW CIRCLE DR
Practice Address - Street 2:
Practice Address - City:CREST HILL
Practice Address - State:IL
Practice Address - Zip Code:60435-2062
Practice Address - Country:US
Practice Address - Phone:815-725-5868
Practice Address - Fax:815-728-5853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL5100844310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility