Healthcare Provider Details

I. General information

NPI: 1811967078
Provider Name (Legal Business Name): WILLOW BROOK CHRISTIAN SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WILLOW BROOK WAY SOUTH
DELAWARE OH
43015
US

IV. Provider business mailing address

100 WILLOW BROOK WAY SOUTH
DELAWARE OH
43015
US

V. Phone/Fax

Practice location:
  • Phone: 740-369-0048
  • Fax: 740-368-4630
Mailing address:
  • Phone: 740-369-0048
  • Fax: 740-368-4630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2085N3705
License Number StateOH

VIII. Authorized Official

Name: MRS. TERRY G MARTINI
Title or Position: FINANCE DIRECTOR
Credential:
Phone: 740-368-4621