Healthcare Provider Details

I. General information

NPI: 1952302788
Provider Name (Legal Business Name): WILLOW HEALTH CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 06/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2646 STATE ROUTE 76
WILLOW SPRINGS MO
65793-8254
US

IV. Provider business mailing address

2646 STATE ROUTE 76 PO BOX 309
WILLOW SPRINGS MO
65793-8254
US

V. Phone/Fax

Practice location:
  • Phone: 417-469-3152
  • Fax: 417-469-3443
Mailing address:
  • Phone: 417-469-3152
  • Fax: 417-469-3443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number031294
License Number StateMO

VIII. Authorized Official

Name: MRS. SHERRY MILLER
Title or Position: CHIEF FINANCIAL OFFICER
Credential: CPA
Phone: 417-469-3152