Provider Demographics
NPI:1649017286
Name:WILLOW HAVEN WELLNESS
Entity type:Organization
Organization Name:WILLOW HAVEN WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:DEY
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:304-620-2150
Mailing Address - Street 1:65 TARLETON DR
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25403-5189
Mailing Address - Country:US
Mailing Address - Phone:307-256-0988
Mailing Address - Fax:
Practice Address - Street 1:195 CAPON SCHOOL ST.
Practice Address - Street 2:STE 5
Practice Address - City:CAPON BRIDGE
Practice Address - State:WV
Practice Address - Zip Code:26711-0373
Practice Address - Country:US
Practice Address - Phone:304-620-2150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-11
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty