Provider Demographics
NPI:1356950406
Name:WILLOW TREE HOME HEALTH CARE LLC
Entity type:Organization
Organization Name:WILLOW TREE HOME HEALTH CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MATSKO
Authorized Official - Suffix:
Authorized Official - Credentials:RN-BC, BSN
Authorized Official - Phone:814-810-2389
Mailing Address - Street 1:374 PHOENIX AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTE
Mailing Address - State:PA
Mailing Address - Zip Code:16823-1309
Mailing Address - Country:US
Mailing Address - Phone:814-810-2389
Mailing Address - Fax:
Practice Address - Street 1:374 PHOENIX AVE
Practice Address - Street 2:
Practice Address - City:BELLEFONTE
Practice Address - State:PA
Practice Address - Zip Code:16823-1309
Practice Address - Country:US
Practice Address - Phone:814-810-2389
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-24
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1038821040001Medicaid