Healthcare Provider Details

I. General information

NPI: 1982101218
Provider Name (Legal Business Name): WILLARD HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2018
Last Update Date: 04/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 E HOWARD ST
WILLARD OH
44890-1656
US

IV. Provider business mailing address

544 ENTERPRISE DR
LEWIS CENTER OH
43035-9704
US

V. Phone/Fax

Practice location:
  • Phone: 419-935-0148
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: PAUL BERGSTEN
Title or Position: MANAGING MEMBER
Credential:
Phone: 937-825-6622