Healthcare Provider Details

I. General information

NPI: 1275403115
Provider Name (Legal Business Name): WILLOW NURSING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2025
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9625 MARKET ST
NORTH LIMA OH
44452-8564
US

IV. Provider business mailing address

9625 MARKET ST
NORTH LIMA OH
44452-8564
US

V. Phone/Fax

Practice location:
  • Phone: 330-549-3939
  • Fax:
Mailing address:
  • Phone: 330-549-3939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: LARRY VALLENBUR
Title or Position: COUNCIL
Credential:
Phone: 330-549-3939