Healthcare Provider Details

I. General information

NPI: 1871463315
Provider Name (Legal Business Name): HALLOWSTONE WILLMAR OPERATING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2025
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 19TH AVE SW
WILLMAR MN
56201-4940
US

IV. Provider business mailing address

12811 KENWOOD LN STE 218
FORT MYERS FL
33907-5645
US

V. Phone/Fax

Practice location:
  • Phone: 239-292-1513
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: AYLA HARWOOD
Title or Position: COO
Credential:
Phone: 239-292-1513