Healthcare Provider Details

I. General information

NPI: 1609886159
Provider Name (Legal Business Name): WILLOW RIDGE OF NC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 02/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 TRYON RD
RUTHERFORDTON NC
28139-3058
US

IV. Provider business mailing address

237 TRYON RD
RUTHERFORDTON NC
28139-3058
US

V. Phone/Fax

Practice location:
  • Phone: 828-286-7200
  • Fax: 828-287-3668
Mailing address:
  • Phone: 828-286-7200
  • Fax: 828-287-3668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH0590
License Number StateNC

VIII. Authorized Official

Name: MARCELLA GRAF
Title or Position: EXECUTIVE CONTROLLER
Credential:
Phone: 224-377-2400