Provider Demographics
NPI:1780953331
Name:WILLOW BROOK ASSISTED LIVING
Entity type:Organization
Organization Name:WILLOW BROOK ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:406-320-1495
Mailing Address - Street 1:3932 PALISADES PARK DR
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-0134
Mailing Address - Country:US
Mailing Address - Phone:406-534-3090
Mailing Address - Fax:406-534-3090
Practice Address - Street 1:3932 PALISADES PARK DR
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-0134
Practice Address - Country:US
Practice Address - Phone:406-534-3090
Practice Address - Fax:406-534-3090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-27
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT12879310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility