Healthcare Provider Details

I. General information

NPI: 1609922020
Provider Name (Legal Business Name): WILLOWOOD CARE CENTER OF BRUNSWICK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 04/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1186 HADCOCK RD
BRUNSWICK OH
44212-3016
US

IV. Provider business mailing address

1186 HADCOCK RD
BRUNSWICK OH
44212-3016
US

V. Phone/Fax

Practice location:
  • Phone: 330-225-3156
  • Fax: 330-273-4876
Mailing address:
  • Phone: 330-225-3156
  • Fax: 330-273-4876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number4774
License Number StateOH

VIII. Authorized Official

Name: DEBORAH LOUGHEED
Title or Position: ADMINISTRATOR
Credential: LNHA
Phone: 330-225-3156