Healthcare Provider Details

I. General information

NPI: 1932138823
Provider Name (Legal Business Name): WILLOUGH HEALTHCARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9001 TAMIAMI TRL E
NAPLES FL
34113-3304
US

IV. Provider business mailing address

7074 GROVE RD # 129
BROOKSVILLE FL
34609-8658
US

V. Phone/Fax

Practice location:
  • Phone: 239-775-4500
  • Fax: 239-755-2990
Mailing address:
  • Phone: 813-978-1933
  • Fax: 352-610-9996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number4212
License Number StateFL

VIII. Authorized Official

Name: TRACY ROBERTS
Title or Position: DIRECTOR REVENUE CYCLE MANAGEMENT
Credential:
Phone: 423-895-0084