Healthcare Provider Details

I. General information

NPI: 1538368816
Provider Name (Legal Business Name): WATSON WILLOW HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2007
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 WHITMORE LN
UKIAH CA
95482-6931
US

IV. Provider business mailing address

131 WHITMORE LN
UKIAH CA
95482-6931
US

V. Phone/Fax

Practice location:
  • Phone: 707-462-6636
  • Fax: 707-462-1809
Mailing address:
  • Phone: 707-462-6636
  • Fax: 707-462-1809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: EDITA PARAISO DE LIMA
Title or Position: PRESIDENT
Credential: RN
Phone: 707-462-6636