Provider Demographics
NPI:1356170302
Name:GREEN WILLOW HOME CARE
Entity type:Organization
Organization Name:GREEN WILLOW HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSEE/ ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSEMARIE
Authorized Official - Middle Name:ATIENZA
Authorized Official - Last Name:SUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-835-8706
Mailing Address - Street 1:950 S WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-7845
Mailing Address - Country:US
Mailing Address - Phone:909-835-8706
Mailing Address - Fax:909-341-5647
Practice Address - Street 1:1386 PORFIRIO ELIAS WAY
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-1635
Practice Address - Country:US
Practice Address - Phone:909-835-8887
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care