Healthcare Provider Details

I. General information

NPI: 1982508222
Provider Name (Legal Business Name): WILLOWS PREMIER HOME CARE AGENCY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5713 WHITE PINE LN
FAIRFIELD TOWNSHIP OH
45011-4588
US

IV. Provider business mailing address

5713 WHITE PINE LN
FAIRFIELD TOWNSHIP OH
45011-4588
US

V. Phone/Fax

Practice location:
  • Phone: 513-345-0729
  • Fax:
Mailing address:
  • Phone: 513-345-0729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: GWENDOLYN BAUGH
Title or Position: PARTNER
Credential: NP
Phone: 513-345-0729