Healthcare Provider Details

I. General information

NPI: 1013895010
Provider Name (Legal Business Name): WILLOWGROVE HOMECARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2025
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 JW PLAZA DR SE STE 10
CALHOUN GA
30701-1503
US

IV. Provider business mailing address

105 JW PLAZA DR SE STE 10
CALHOUN GA
30701-1503
US

V. Phone/Fax

Practice location:
  • Phone: 706-383-6376
  • Fax:
Mailing address:
  • Phone: 706-383-6376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MARINA PARKER
Title or Position: ADMINISTRATOR
Credential:
Phone: 706-383-6376