Healthcare Provider Details

I. General information

NPI: 1699645945
Provider Name (Legal Business Name): WILLOWS PLACE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

1910 WILLOW RD
GREENSBORO NC
27406-3855
US

IV. Provider business mailing address

1910 WILLOW RD
GREENSBORO NC
27406-3855
US

V. Phone/Fax

Practice location:
  • Phone: 336-362-6811
  • Fax:
Mailing address:
  • Phone: 336-362-6811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MR. STEVE SIMMONS
Title or Position: MANAGER MGR
Credential:
Phone: 336-362-6811